Comparing the Use of Physiotherapy, Shockwave Therapy, Prolotherapy, and Platelet-Rich Plasma for Chronic Lateral Epicondylosis: A Prospective, Randomized Controlled Trial With 2-Year Follow-up

Lateral epicondylosis is a degenerative condition affecting 1% to 3% of adults annually. Concerns over the sustained efficacy of corticosteroids have increased interest in regenerative treatments like platelet-rich plasma (PRP), prolotherapy, and extracorporeal shockwave therapy (ESWT), but comparative data remain limited. To evaluate whether PRP, prolotherapy, and ESWT provide superior clinical outcomes at 24 months compared with physiotherapy alone in patients with chronic lateral epicondylosis. Randomized controlled trial; Level of evidence, 2. Adults older than 35 years with lateral elbow pain lasting >6 months, diagnosed via physical examination and ultrasound, and refractory to at least 3 months of nonoperative treatment, were included. Exclusion criteria included recent corticosteroid or botulinum toxin injections and complete extensor tendon rupture. Patients were randomized into 4 treatment groups: physiotherapy, ESWT, prolotherapy, or PRP. The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) score, and the secondary outcome was the Subjective Satisfaction Score (SSS). Patients were followed for 2 years to assess the treatment efficacy. A total of 231 patients were enrolled, with 202 completing the study. Baseline DASH scores were comparable across the groups (P = .526). At 24 months, PRP significantly reduced DASH scores by 31.18 points compared with physiotherapy (18.70 points) and ESWT (17.62 points) (P < .01). Prolotherapy (21.02 points) also showed greater improvement than physiotherapy at 18 months (15.61 points) (P < .01). PRP yielded the highest SSS (4.60 ± 0.9), outperforming physiotherapy (3.00 ± 1.9) and ESWT (3.43 ± 1.7) (P < .01). Prolotherapy also yielded higher SSS (4.24 ± 1.2) compared with physiotherapy (P < .01) and ESWT (P < .01) at 24 months. At 24 months, all groups demonstrated DASH score reductions exceeding the minimal clinically important difference of 10 points, indicating clinically meaningful improvement: PRP (31.18), prolotherapy (20.70), ESWT (17.62), and physiotherapy (18.70). PRP and prolotherapy yielded better clinical and functional outcomes than ESWT and physiotherapy in chronic lateral epicondylosis over a 2-year follow-up. The findings support the potential of these therapies as effective nonsurgical options for long-standing cases.