The New York Times, May 13, 2019: “Stem Cell Treatments Flourish With Little Evidence That They Work”
What is the role of biologic treatments in shoulders and elbows? Doctors and patients alike are interested to know if platelet rich plasma (PRP), bone marrow aspirate stem cells, or adipose derived stem cells can stimulate healing of damaged tissue. In fact, there is a lot of conflicting data, making it hard to reach a conclusion. This excellent review article by Dr. Jason Dragoo does a great job analyzing the studies we have to date on the use of biologics in the elbow. One of the article's conclusions is that PRP is superior to corticosteroid injections for lateral epicondylitis (tennis elbow). This is not too surprising given that we know tennis elbow is a lack of inflammation and healing. Previous authors have discouraged the use of steroid injections for tennis elbow. However, Dragoo goes further and states that PRP can be recommended as a first line treatment given the current literature. He goes on to say that stem cell treatment can't be definitely recommended due to the lack of data on it.
Comment: I think it's reasonable to offer PRP to patients with lateral epicondylitis as a primary treatment. It can take months or years to recover from tennis elbow. Those who are impatient for results may consider PRP as a shortcut to recovery. However, patients should be aware of the 73% success rate at 1 year. Furthermore, the treatment is not covered by insurance and the cost can be around $600 per treatment.