Ultrasound-guided injection strategies for lateral epicondylitis: a multicenter randomized comparison of corticosteroid, platelet-rich plasma, and ozone.

OBJECTIVE: To compare the effectiveness of ultrasound-guided injections of corticosteroid, platelet-rich plasma (PRP), and ozone for treating chronic lateral epicondylitis.

METHODS: This multi-center, three-arm, assessor-blinded, randomized controlled trial enrolled 90 patients with chronic lateral epicondylitis. Participants were randomized in a 1:1:1 ratio to receive a single ultrasound-guided injection of either methylprednisolone, low-leukocyte PRP, or medical ozone. The primary outcomes were pain on the visual analog scale (VAS), function via the Mayo Elbow Performance Index (MEPI), and the pressure pain threshold (PPT), assessed at baseline, 8 weeks, and 6 months.

RESULTS: Eighty of the 90 randomized patients completed the study. All three treatment groups demonstrated statistically significant improvements from baseline across all primary outcome measures at both the 8-week and 6-month follow-ups (p < .05 for all). However, the primary comparative analysis revealed no statistically significant differences between the corticosteroid, PRP, and ozone groups for any outcome measure at any follow-up time point (p > .05 for all between-group comparisons).

CONCLUSION: Ultrasound-guided injections of corticosteroid, low-leukocyte PRP, and ozone are all effective treatments for improving pain and function in patients with chronic lateral epicondylitis at 6 months. As no single agent proved statistically superior, the choice of therapy should be guided by a process of shared decision-making that considers factors such as patient preference, cost, and desired timeline for relief.