Tennis elbow, medically referred to as lateral epicondylitis, is a common condition characterized by pain and tenderness over the lateral aspect of the elbow, primarily affecting the origin of the extensor carpi radialis brevis tendon. It results from repetitive overuse, leading to microtears and degeneration rather than inflammation of the tendon fibers. Traditional management strategies include physiotherapy, activity modification, oral nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroid injections, and, in refractory cases, surgery. However, many of these treatments only provide symptomatic relief without addressing the underlying tendon pathology. In recent years, platelet-rich plasma (PRP) therapy has emerged as a biologically based treatment modality aimed at promoting tendon healing and regeneration rather than merely reducing symptoms [1].

Pathophysiology of Tennis Elbow

The pathophysiology of tennis elbow involves tendinosis rather than tendinitis, characterized by fibroblast proliferation, increased vascularity, and disorganized collagen without the presence of inflammatory cells [2]. PRP, derived from autologous blood after centrifugation, contains a concentration of platelets significantly above baseline levels. These platelets release various growth factors, including platelet-derived growth factor (PDGF), transforming growth factor-beta (TGF-β), and vascular endothelial growth factor (VEGF), all of which stimulate tissue repair by enhancing angiogenesis, collagen synthesis, and cellular proliferation [3,4].

Clinical Evidence Supporting PRP in Tennis Elbow

Clinical evidence supporting the use of PRP in the management of tennis elbow has grown substantially. Alzahrani et al. conducted a retrospective study showing significant improvements in pain scores and functional outcomes in patients who received PRP injections compared to baseline assessments [5]. Ye et al. performed a systematic review and meta-analysis of multiple randomized controlled trials, demonstrating that PRP injections lead to more substantial and sustained   improvements in pain and function compared to   corticosteroid  injections   over   follow-up   periods extending beyond six months [6]. Similarly, Gupta reported that patients treated with PRP experienced better long-term outcomes with lower recurrence rates than those receiving traditional steroid therapy [13]. In a randomized controlled trial, Peerbooms et al. found that PRP-treated patients had a 60% improvement in symptoms at one year compared to only 24% in the corticosteroid group [10]. These findings were further corroborated by Fitzpatrick et al., who confirmed through meta-analysis that PRP injections were significantly more effective in improving pain and function in chronic tendinopathies, including lateral epicondylitis, than control interventions [9]. The growing body of evidence thus supports PRP as a superior alternative to conventional treatment methods, particularly for patients with chronic or refractory tennis elbow.

Comparing PRP with Corticosteroids

When comparing PRP injections with corticosteroid injections, several important differences emerge. Corticosteroid injections have been the traditional choice for rapid symptom relief in tennis elbow; however, their benefits are typically short-lived. Studies have shown that while steroids provide quick pain relief within the first few weeks’ post-injection, the effects tend to diminish within three to six months, and repeated steroid use may even predispose the tendon to further degeneration and increased risk of rupture [7]. In contrast, PRP injections promote actual healing of the degenerative tendon by stimulating reparative processes. Although pain relief from PRP may be slower initially, patients receiving PRP injections have demonstrated sustained improvements lasting up to two years post-treatment [8]. Additionally, PRP avoids the deleterious catabolic effects associated with steroids, making it a more suitable choice for long-term management, particularly in athletes and physically active individuals.

Recent evidence

Recent advances in PRP therapy for tennis elbow have focused on optimizing the biological activity of PRP and improving delivery methods. One notable innovation involves the development of leukocyte-poor PRP (LP-PRP), which minimizes the pro-inflammatory effects of white blood cells while retaining the regenerative potential of platelets. Studies have suggested that LP-PRP may result in less post-injection inflammation and better clinical outcomes compared to leukocyte-rich PRP [9]. Another promising advance is the combination of PRP with scaffold materials such as allodermal matrix or collagen matrices. For instance, Yoon et al. reported that injection of a mixture of PRP and an allodermal matrix led to improved tendon integrity and faster clinical recovery compared to PRP alone [12]. Additionally, minimally invasive ultrasound-guided injection techniques have improved the accuracy of PRP delivery to the affected tendon, ensuring better localization and enhancing treatment efficacy [10]. Research is also exploring the use of bioengineered PRP formulations and adjunctive therapies, such as shockwave therapy combined with PRP, to further enhance tendon regeneration. Such innovations aim to refine PRP protocols and broaden its applicability across different stages and severities of tendon pathology.

In conclusion, local injection of platelet-rich plasma offers a regenerative, safe, and effective treatment option for patients suffering from tennis elbow, addressing the root cause of tendinopathy rather than merely alleviating symptoms. The growing evidence base supports its use as a preferred therapy over corticosteroids for long-term outcomes. Recent technological and biological advancements continue to enhance the therapeutic potential of PRP, making it a promising mainstay in the future management of chronic tendinopathies.

1. Maffulli, N., U.G. Longo, and V. Denaro. “Platelet-Rich Plasma Injections in the Treatment of Chronic Tendinopathies: A Review.” British Medical Bulletin, vol. 93, 2010, pp. 159–174, https://doi.org/10.1093/bmb/ldp040.

2. Kraushaar, B.S., and R.P. Nirschl. “Tendinosis of the Elbow (Tennis Elbow).” American Journal of Sports Medicine, vol. 27, no. 3, 1999, pp. 375–380, https://doi.org/10.1177/03635465990270032101.

3. Foster, T.E., B.L. Puskas, B.R. Mandelbaum, et al. “Platelet-Rich Plasma: From Basic Science to Clinical Applications.” American Journal of Sports Medicine, vol. 37, no. 11, 2009, pp. 2259–2272, https://doi.org/10.1177/0363546509349921.

4. Anitua, E., M. Sánchez, G. Orive, and I. Andia. “The Potential Impact of PRP in Regenerative Medicine.” Trends in Biotechnology, vol. 24, no. 5, 2006, pp. 227–234, https://doi.org/10.1016/j.tibtech.2006.03.001.

5. Alzahrani, O.H., et al. “Efficacy of Platelet-Rich Plasma Injection in the Management of Lateral Epicondylitis: A Retrospective Assessment.” Cureus, 2025, https://www.cureus.com/articles/326221-efficacy-of-platelet-rich-plasma-injection-in-the-management-of-lateral-epicondylitis-a-retrospective-assessment.pdf.

6. Ye, Z., et al. “Platelet-Rich Plasma and Corticosteroid Injection for Tendinopathy: A Systematic Review and Meta-Analysis.” BMC Musculoskeletal Disorders, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC11980122/.

7. Krogh, T.P., U. Fredberg, K. Stengaard-Pedersen, et al. “Treatment of Lateral Epicondylitis with Corticosteroid, PRP, or Saline: A Double-Blind Randomized Controlled Trial.” American Journal of Sports Medicine, vol. 41, no. 3, 2013, pp. 625–635, https://doi.org/10.1177/0363546512472975.

8. Mishra, A., and T. Pavelko. “Treatment of Chronic Elbow Tendinosis with Buffered Platelet-Rich Plasma.” American Journal of Sports Medicine, vol. 34, no. 11, 2006, pp. 1774–1778, https://doi.org/10.1177/0363546506288850.

9. Fitzpatrick, J., M. Bulsara, and M.H. Zheng. “The Effectiveness of Platelet-Rich Plasma in the Treatment of Tendinopathy: A Meta-Analysis of RCTs.” American Journal of Sports Medicine, vol. 45, no. 1, 2017, pp. 226–233, https://doi.org/10.1177/0363546516643716.

10. Peerbooms, J.C., et al. “Positive Effect of an Autologous Platelet Concentrate in Lateral Epicondylitis in a Double-Blind RCT: PRP versus Corticosteroid Injection with 1-Year Follow-Up.” American Journal of Sports Medicine, vol. 38, no. 2, 2010, pp. 255–262, https://doi.org/10.1177/0363546509355445.

11. Karjalainen, T.V., et al. “Can Surgeons or Patients Predict the Likelihood of Improvement with Nonoperative Treatment of Chronic Tennis Elbow?” Clinical Orthopaedics and Related Research, 2025, https://researchportal.helsinki.fi/en/publications/can-surgeons-or-patients-predict-the-likelihood-of-improvement-wi.

12. Yoon, E.J., J.W. Lee, and J.H. Kim. “Injection of an Allodermal Matrix and Leukocyte-Rich PRP Mixture Improved Tendon Integrity in Lateral Epicondylitis.” Medicine (Baltimore), 2024, https://journals.lww.com/md-journal/fulltext/2024/12200/injection-of-an-allodermal-matrix and.78.aspx.

13. Gupta, S.K. “A Comparative Analysis of PRP versus Corticosteroid Injections in the Management of Tendinopathies.” International Journal of Life Sciences and Biotechnology Research, 2024, https://www.ijlbpr.com/uploadfiles/35vol13issue8pp212-216.20240815040644.pdf.