Regenerative Medicine for the Elbow

Regenerative treatments for injuries about the elbow are best supported by many RCTs that examine outcomes in the treatment of common extensor tendinopathy. Studies suggest that PRP injections have long-term therapeutic benefit when compared to corticosteroid injection, local anesthetic injections, and conservative management alone, but the efficacy of PRP compared to mechanical debridement with percutaneous ultrasonic tenotomy or surgery has not been described in well-controlled studies. There is variability in the literature in the formulation of PRP, inconsistent use of additional procedures (percutaneous needle tenotomy) and sonographic guidance to perform the injection, as well as varied postinjection rehabilitation protocols across studies. There is limited evidence for the use of ABI, prolotherapy, ATI, BMAC, adipose tissue, amniotic membrane, and PUT with none of these treatments consistently showing superiority to other management options. Beyond treatment for common extensor tendinopathy, the data is limited by small sample sizes and case series or case studies but suggests that regenerative treatments such as PRP, prolotherapy, and BMAC might have promise in treating other injuries involving the elbow including common flexor/pronator tendinopathy, UCL injury, distal biceps tendinopathy, and distal triceps tendinopathy. There is limited evidence for the use of regenerative therapies to treat elbow arthritis, but based on our knowledge of the use of PRP to treat arthritis of other joints, it may also show efficacy in the elbow. Lastly, regenerative therapies have only been used to augment surgery for OCD and are less likely to be beneficial when injected in the setting of stable OCD.