Autologous Blood Injections (ABI) for Tennis Elbow

EFFECTIVENESS: 2/5

Recent evaluations of prior studies have shown that Platelet Rich Plasma Injections (PRP) is more effective than ABI and Corticosteroid Injections (CSI), but other studies have shown opposite results.

Source:

Thanasas, G. Papadimitriou, C. Charalambidis, I. Paraskevopoulos, and A. Papanikolaou, “Platelet-rich plasma versus autologous whole blood for the treatment of chronic lateral elbow epicondylitis: a randomized controlled clinical trial,” American Journal of Sports Medicine, vol. 39, no. 10, pp. 2130–2134, 2011

A more recent study comparing Corticosteroid Injection and ABI concluded there was little to no quality evidence that either one was helpful in the medium or long term for Lateral Epicondyle Tendinopathy (LET). Another study concluded that ABI was less effective than PRP with more risk.

Sources:

Sirico F, Ricca F, DI Meglio F, Nurzynska D, Castaldo C, Spera R, Montagnani S. Local corticosteroid versus autologous blood injections in lateral epicondylitis: meta-analysis of randomized controlled trials. Eur J Phys Rehabil Med. 2017 Jun;53(3):483-491. doi: 10.23736/S1973-9087.16.04252-0. Epub 2016 Sep 1.

Arirachakaran A, Sukthuayat A, Sisayanarane T, Laoratanavoraphong S, Kanchanatawan W, Kongtharvonskul J. Platelet-rich plasma versus autologous blood versus steroid injection in lateral epicondylitis: systematic review and network meta-analysis. Journal of Orthopaedics and Traumatology : Official Journal of the Italian Society of Orthopaedics and Traumatology. 2016;17(2):101-112. doi:10.1007/s10195-015-0376-5.

SELF CARE: 0/5

While it might theoretically be possible to perform this procedure on oneself, we deem it unlikely.

COST: 4/5

While the costs for ABI are less than for PRP, they can range from less than $100 per visit, to hundreds of dollars per injection and may require multiple injections. Typically, insurance carriers consider it “experimental” and therefore not covered.

USEFULNESS (overall rating): 3/5

As with PRP injections, the theory regarding injecting whole blood into the area of injury is that it will stimulate healing within the tissues. Blood contains growth factors, though they are in much higher concentrations in Platelet Rich Plasma (PRP). ABI involves injecting venous blood, typically combined with lidocaine (a numbing medication) which is then injected into the area of the lateral epicondyle. There are a limited number of studies evaluating how effective ABI is, but there seems to be a consensus that it is less effective than PRP, but more effective over the long term than corticosteroid injections.

Sources:

Bhabra G, Wang A, Ebert JR, Edwards P, Zheng M, Zheng MH. Lateral Elbow Tendinopathy: Development of a Pathophysiology-Based Treatment Algorithm. Orthop J Sports Med. 2016 Nov 1;4(11):2325967116670635. eCollection 2016 Nov.

Patients should understand that the procedure is painful, and the pain can last 3-4 days or more. In addition, it can take weeks to see benefit, if then, and patients may need 1-6 injections over time to see any benefit. For these reasons, ABI is not typically done early in treatment, but rather when other forms of treatment have not helped.