HYALURONIC ACID INJECTIONS FOR TENNIS ELBOW: A SYSTEMATIC REVIEW

D. Tarantino¹, B. Corrado^1*, R. Mottola¹, R. Gnasso¹, S. Palermi¹, F. Sirico¹, C. Ruosi¹, R. Saggini², R. Pellegrino³ and R. Aicale⁴

¹Department of Public Health, University of Naples Federico II, Naples, Italy
²Department of Psychology, e-Campus University, Novedrate, Italy;
³Department of Scientific Research, Campus Ludes, Off-Campus Semmelweis University, Lugano, Switzerland
⁴Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Baronissi, Italy

Correspondence to:
Bruno Corrado, MD PhD
Department of Public Health,
University of Naples Federico II,
80131 Naples, Italy
e-mail address: bruno.corrado@unina.it

Received: 10 April 2024 Accepted: 12 May 2024

ISSN 2975-044X (online) ISSN 2038-4106 (print) Copyright © by BIOLIFE 2024 This publication and/or article is for individual use only and may not be further reproduced without written permission from the copyright holder. Unauthorized reproduction may result in financial and other penalties. Disclosure: All authors report no conflicts of interest relevant to this article.

ABSTRACT

                Tennis elbow is a tendinopathy of the lateral elbow that causes pain and functional limitation. This systematic review investigates the effects of hyaluronic acid injections for treating tennis elbow. A systematic search of scientific electronic databases (CENTRAL, EMBASE, MEDLINE, PEDro, Web of Science, Scopus, PubMed, and CINAHL) was performed up to October 2023 with no restrictions of time and language. This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria were articles that reported clinical outcomes about the use of hyaluronic acid for tennis elbow alone or in comparison with other injectable drugs. Outcome measures were the Visual Analogue Scale, handgrip strength, and the Quick-Disabilities of the Arm, Shoulder, and Hand score. Two independent authors performed the search and evaluated the articles. The inter-rater reliability in the quality assessment was evaluated using Cohen’s kappa coefficient. The Modified Coleman Methodology Score was used to evaluate the methodological quality of the articles included in this systematic review. A total of seven articles were included with the overall quality of the included articles being evaluated as fair. Despite using different kinds of hyaluronic acid and injection protocols, and different scores applied, each included study showed clinically relevant improvements. Hyaluronic acid injections resulted in being superior to placebo but inferior in the short-term compared to other injections. Given the high heterogeneity of the included studies, we cannot conclude which kind of hyaluronic acid and injection protocol is the best for treating tennis elbow. Hyaluronic acid injections for treating tennis elbow seem safe and effective in reducing pain, improving function, and allowing a faster return to pain-free sports activities especially in the long term. High-quality and prospective long-term follow-up studies are needed to confirm the articles’ outcomes in this systematic review.

 KEYWORDS: tennis elbow, TE, lateral epicondylitis, epicondylitis, hyaluronic acid, HA, injections