Comparison of the effects of sodium hyaluronate-chondroitin sulphate and corticosteroid in the treatment of lateral epicondylitis: a prospective randomized trial

Abstract

BackgroundHyaluronic acid and glycosaminoglycans have shown positive effects in improving lateral epicondylitis and other tendinosis conditions. Therefore, we designed a prospective, randomized study to compare the effects of a combined sodium hyaluronate and chondroitin sulfate (HA+CS) injection versus a triamcinolone injection in the treatment of lateral epicondylitis. MethodsIn total, 57 consecutive patients with clinically diagnosed lateral epicondylitis were divided randomly into two groups. In the HA+CS group, 25 patients received a single injection of a solution containing an HA+CS combination and prilocaine HCl, while the 32 patients in the triamcinolone group received a single injection of a solution of triamcinolone and prilocaine HCl. We evaluated the pain and function outcome measures using the PatientRated Tennis Elbow Evaluation (PRTEE) questionnaire at the beginning of the study, and 3 and 6months after the injection. Additionally, the Minimum Clinically Important Difference values and percentage changes in the PRTEE subscale scores between the assessments were calculated. ResultsNo serious adverse events were reported throughout the study. The mean pain and function scores for the HA+CS and triamcinolone groups had significantly improved at 3months, but the mean function scores in the HA+CS group were statistically significantly better when compared to the triamcinolone group. At 6months, both groups had significantly improved mean pain and function scores, compared to the baseline scores; however, the mean pain and function scores in the 6-month HA+CS treatment group were better than in the 6-month triamcinolone group. The relative change for the mean total score in the HA+CS group was much better when compared with the triamcinolone group, and the HA+CS treatment group showed clinically significant improvement when compared with triamcinolone group at 3 and 6months. ConclusionsThis study supports the idea that for a single injection treatment of patients with lateral epicondylitis, a combination injection of HA+CS may offer better pain benefits for 6months after injection, when compared to triamcinolone.Type of study/level of evidenceLevel II, Randomized Clinical Trial, Prospective Comparative Study.