Platelet-Rich Plasma Injections are Associated with Higher Resource Utilization and Surgical Escalation Compared with Corticosteroids in Lateral Elbow Tendinopathy - Real-world Study

Sep 29, 2026

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Epicondylitis is a common tendinopathy in adults, and real-world comparative effectiveness between platelet-rich plasma (PRP) and corticosteroid injections (CSI) remains uncertain. A retrospective cohort study using de-identified TriNetX electronic health records (2010–2025) matched adults with coded epicondylitis receiving PRP or CSI. After propensity matching, PRP showed higher short-term risks of repeat/new medication use, opioid exposure, PT utilization, and surgical escalation, with no significant differences for ED visits or long-term opioid initiation.

LanguageEnglish

CategoryHealthcare

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Pages9

Reading Time23 min

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Introduction

Materials and Methods

Results

Conclusion

Keywords

Original Article Journal of Orthopaedic Case Reports 2025 December:15(12):Page 274-282 Platelet-Rich Plasma Injections are Associated with Higher Resource Utilization and Surgical Escalation Compared with Corticosteroids in Lateral Elbow Tendinopathy Aamir Shahzad1, Haji Bahar Ali2, Zim Warda Hassan3, Syed Amir Ali Shah4, Abeeha Oz, Wiqqas Jamil1 Learning Point of the Article: In real-world practice, PRP for epicondylitis was associated with greater short-term treatment failure and healthcare utilization than CSI, highlighting an eﬃcacy–eﬀectiveness gap and the need for standardized protocols and patient counseling. Abstract Introduction: Epicondylitis (lateral and medial) is a common tendinopathy that impairs function and quality of life. Corticosteroid injections (CSI) provide rapid but oěen short-lived symptom relief, while platelet-rich plasma (PRP) is used as a biologic alternative aimed at tendon regeneration. Comparative eﬀectiveness between PRP and CSI remains uncertain in real-world seĨings. Materials and Methods: We conducted a retrospective cohort study using de-identiėed electronic health records from the TriNetX Network (2010–2025). Adults ≥18 years with coded epicondylitis and subsequent PRP or CSI were included. Cohorts were 1:1 propensity-score matched on demographics and comorbidities (age, sex, race, type 2 diabetes, obesity, hypothyroidism, nicotine dependence). Outcomes were assessed over a period of 1 year aěer the index event and included repeat or new medication, opioid exposure, long-term opioid initiation, visits to the emergency department (ED), functional diagnoses (stiﬀness, weakness, mobility), physical therapy (PT) utilization, and surgical escalation. Hazard ratios (HRs) and risk ratios were estimated. Results: Aěer matching, 1,064 PRP patients were compared with 1,064 CSI patients. PRP was associated with higher hazards of repeat or new medication (HR 1.33; 95% CI 1.18–1.50; RR 1.21), opioid exposure (HR 1.48; 95% CI 1.20–1.83; RR 1.43), PT utilization (HR 1.52; 95% CI 1.27–1.81; RR 1.41), joint stiﬀness (HR 1.64; 95% CI 1.04–2.59; RR 1.63), dependence on mobility aids (HR 3.63; 95% CI 1.80–7.31; RR 3.60), and surgical escalation (HR 2.57; 95% CI 1.19–5.56; RR 2.30). No signiėcant diﬀerences were observed for ED visits, long-term opioid initiation, abnormal gait, muscle weakness, or contracture. Conclusion: In this large, multi-institutional real-world cohort, PRP was associated with higher short-term utilization and treatment failure risks compared with CSI. While randomized trials suggest mid-term beneėts ofPRP, our ėndings highlight an eﬃcacy–eﬀectiveness gap, likely reĚecting heterogeneity in PRP protocols and patient selection. Clinicians should counsel patients about the potential for early symptom Ěare and higher downstream resource use when considering PRP. Keywords: Epicondylitis, tennis elbow, platelet-rich plasma, corticosteroid injection, real-world evidence. Introduction elbow”) and less oěen medial, aﬀects working-age adults Epicondylitis, most commonly lateral epicondylitis (“tennis disproportionately and imposes a meaningful clinical and | | Author’s Photo Gallery | | | | | | | --- | --- | --- | --- | --- | --- | --- | |
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Website: [www.jocr.co.in](www.jocr.co.in)

DOI:
hĨ[ps://doi.org/10.13107/jocr.2025.v15.i12.6534](ps://doi.org/10.13107/jocr.2025.v15.i12.6534) | Dr. Haji BaharAli Dr. Zim Warda Hassan Dr. Syed Amir Ali Shah Mr. Wiqqas Jamil

1Department of Trauma and Orthopedic Surgery, Tameside and Glossop Integrated Care NHS Trust, Greater Manchester OL6 9RW, United Kingdom,
2ĉird Year MBBS Student, Punjab Medical College, Faisalabad Medical University, Faisalabad 38000, Pakistan, 3Research Fellow, Clinical and Translational Science, School of Medicine, West Virginia University, USA, 4Department of Trauma and Orthopeadics Surgey, Alama General Hospital, Kingdom of Saudi

FAQs

How was PRP compared with corticosteroid injections in the study?

The study used a retrospective cohort from de-identified TriNetX electronic health records (2010–2025) and performed 1:1 propensity-score matching on demographics and comorbidities.

What outcomes showed higher utilization or failure with PRP versus CSI?

PRP was associated with higher hazards of repeat or new medication, opioid exposure, PT utilization, joint stiffness, dependence on mobility aids, and surgical escalation.

Were there any outcomes that did not differ significantly between PRP and CSI?

No significant differences were observed for ED visits, long-term opioid initiation, abnormal gait, muscle weakness, or contracture.

Sep 29, 2026

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