Bone marrow injection: A novel treatment for tennis elbow
The Regenerative Clinic's view on this research
Mr Ali Noorani “Currently there is some evidence for the use of bone marrow aspirate concentrate (BMAC) for elbow tendinopathy. This includes conditions like tennis elbow. A study published in The Journal of Natural Science Biology and Medicine with level 4 evidence for tennis elbow in 30 patients confirms that the patient rated tennis elbow (PRTEE) is a very sensitive test for tennis elbow. The study found that the score improved from a high score of 73 to a good score of 14 at one year. Although this is an encouraging study, we recognise as a level 4 study, and although it improves efficacy, The Regenerative Clinic acknowledges that there is a significant amount of high-level 1 studies showing efficacy of platelet-rich-plasma (PRP) in tennis elbow, therefore we recommend the use of PRP which has good efficacy confirmed in trials and is of course cheaper than bone marrow aspirate concentrate in use of specific cases of chronic tennis elbow that has not responded to good rehabilitation.”
Objective: The objective of this prospective study was assessment of efficacy of bone marrow aspirate (BMA) (containing plasma rich in growth factors and mesenchymal stem cells) injection in treatment of tennis elbow.
Materials and methods: A total of 30 adult patients of previously untreated tennis elbow were administered single injection of BMA. This concentrate was made by centrifugation of iliac BMA at 2000 rpm for 20-30 min and only upper layer containing platelet rich plasma and mononuclear cells was injected. Assessment was performed at baseline, 2 weeks, 6 weeks and 12 weeks using Patient-rated Tennis Elbow Evaluation (PRTEE) score.
Results: Baseline pre-injection mean PRTEE score was 72.8 ± 6.97 which decreased to a mean PRTEE score of 40.93 ± 5.94 after 2 weeks of injection which was highly significant (P < 0.0001). The mean PRTEE score at 6 week and 12 week follow-up was 24.46 ± 4.58 and 14.86 ± 3.48 respectively showing a highly significant decrease from baseline scores (P < 0.0001).
Conclusion: Treatment of tennis elbow patients with single injection of BMA showed a significant improvement in short to medium term follow-up. In future, such growth factors and/or stem cells based injection therapy can be developed as an alternative conservative treatment for patients of tennis elbow, especially who have failed non-operative treatment before surgical intervention is taken.