Morphological changes in tennis elbow after PRP injection: a novel MRI-based assessment in a randomized controlled...

Lateral epicondylar tendinopathy (tennis elbow) is a degenerative tendinopathy of the common extensor tendon, often affecting individuals engaged in repetitive upper-limb activities. While clinical diagnosis is standard, magnetic resonance imaging (MRI) enables an objective assessment of tendon pathology and treatment response. This randomized controlled trial aimed to evaluate the effect of platelet-rich plasma (PRP) injections on tendon healing in lateral epicondylar tendinopathy using MRI. The primary outcome was the reduction in partial tendon tear size measured on MRI.

A double-blind, randomized, placebo-controlled study was conducted on 71 patients with chronic lateral tendinopathy. MRI scans were performed using a 3T scanner in the "Superman position," assessing common extensor tendon integrity, tendon tears, soft tissue edema, and collateral ligament abnormalities. Patients received leukocyte-rich PRP (LR-PRP), leukocyte-poor PRP, or saline injections. Another MRI was performed at six months following injections. Interobserver reliability was measured using the intraclass correlation coefficient.

The MRI protocol demonstrated excellent reliability (intraclass correlation coefficient >0.90). Statistically significant improvements in tendon structure and muscle edema were observed in all treatment groups, including saline. However, LR-PRP showed a distinct advantage in reducing partial tendon tear size and soft tissue edema, while leukocyte-poor PRP also led to some improvement in soft tissue morphology, though less consistently. Joint effusion was less frequent in both PRP groups compared to control. No significant superiority of PRP over saline was observed in tendinosis resolution or muscle edema reduction at 6-month follow-up.

This study presents a reproducible MRI-based assessment technique for lateral tendinopathy, enhancing diagnostic precision and treatment evaluation. It confirmed a wide dynamicly changing spectrum of pathologies, not strictly limited to tendinopathy (eg, edema, effusion, synovitis, tendon tears, ligament abnormalities, and subchondral cysts). Clearly soft tissue morphology improved with the treatment. While PRP treatments-particularly LR-PRP-offered benefits in specific morphological parameters such as tear size and soft tissue edema, overall improvement patterns suggest that PRP was not universally superior to saline. MRI remains a valuable tool for monitoring structural tendon changes in chronic lateral tendinopathy.