Current Concepts in Platelet-Rich Plasma Therapy for Lateral Epicondylitis Through a Histopathological and Clinical...

Lateral epicondylitis (LE), or tennis elbow, is a degenerative tendinopathy of the extensor carpi radialis brevis (ECRB) tendon. While most patients improve with conservative therapies, a subset experience chronic, refractory symptoms requiring advanced interventions. Platelet-rich plasma (PRP) has emerged as a promising biologic treatment, offering an autologous source of growth factors that may enhance tendon healing. This review examines current concepts in PRP therapy for LE, including basic science mechanisms, animal studies, and clinical outcomes. Chronic LE is characterized by a paucity of inflammatory infiltrate and increased programmed cell death (PCD), suggesting a limited intrinsic healing response. PRP delivers key growth factors (vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF), insulin-like growth factor (IGF), fibroblast growth factor (FGF), and transforming growth factor-beta (TGF-β)), each of which has demonstrated pro-healing properties in animal models by promoting angiogenesis, fibroblast proliferation, and collagen remodeling. Clinical data on PRP are heterogeneous, with some randomized trials and long-term follow-up studies demonstrating significant improvement in pain and function, while others show minimal benefit. Comparisons with corticosteroids suggest that PRP may offer superior long-term outcomes, although corticosteroids provide better short-term relief. PRP has also shown comparable efficacy to surgical debridement, offering a less invasive alternative. The role of leukocyte concentration in PRP remains unresolved; while leukocyte-poor PRP may reduce fibrosis and inflammation, clinical studies have not definitively favored one formulation over another. Overall, PRP therapy represents a biologically plausible, relatively safe, and potentially effective treatment option for refractory LE. Further research is needed to optimize formulation, delivery, and patient selection to fully realize its clinical utility.