Lateral Epicondylitis Clinical Trial
Official title:
Injection Therapy in Patients With Lateral Epicondylitis: Hyaluronic Acid or Prolotherapy?
Lateral epicondylitis is a painful enthesopathy of the common extensor tendon at the lateral part of the elbow, with a prevalence of 1-3 % in the general population. In the treatment of lateral epicondylitis, the role of biological-based therapies has begun to investigate regeneration and optimize tendon healing. Prolotherapy (PrT) and hyaluronic acid (HA) injections are biological based treatments. Previous studies have shown benefit of PrT in the treatment of tendinopathies. Preliminary findings demonstrated that HA could be clinically effective in the treatment of enthesopathies. Considering the paucity of HA studies (which also lack a control group) and the proposed mechanism of action of both PrT and HA is through cell proliferation and the healing process of tendons, this study was conducted to compare the effect of PrT and HA in chronic lateral epicondylitis .
Lateral epicondylitis and other chronic tendinopathies are now understood to be
non-inflammatory conditions characterized by collagen degeneration, fibroblast proliferation,
mucoid degeneration and neovascularization Biological-based treatments can trigger the
release of cytokines and growth factors from platelets, leukocytes, macrophages and other
inflammatory cells. These growth factors support neovascularization and the chemotaxis of
fibroblasts and tenocytes. It stimulates proliferation and collagen remodeling of fibroblasts
and tenocytes.
PrT involves multiple injections of a small amount of irritant or sclerosing solution. Common
irritants include hypertonic dextrose, phenol-glycerin-glucose and sodium morrhuate. PrT
injection mechanism is as follows; while hypertonic dextrose causes cell rupture through
osmosis, monosodium morrhuate attracts inflammatory mediators and improves blood flow of the
diseased tendon.Previous studies have shown benefit of PrT in the treatment of tendinopathies
HA injection is a treatment method that increases the ability of sliding with its
viscoelastic properties, reduces tendon surface friction and accelerates regeneration. In
vitro models suggest that HA can increase collagen I production and accumulation with a
dose-dependent positive collagen I / collagen III ratio. However, controlled randomised
studies are still needed.
Mechanism of action of both PrT and HA is cell proliferation and the healing process of
tendons, this study was conducted to compare the effect of PrT and HA in chronic lateral
epicondylitis .
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