Synergistic effects of polydeoxyribonucleotide with shockwave therapy and exercise for lateral epicondylitis: a randomized controlled trial

Abstract Extensor muscle strengthening exercise (EMSE) and extracorporeal shockwave therapy (ESWT) are established treatments for chronic lateral epicondylitis (LE) of the elbow. Polydeoxyribonucleotide (PDRN) is also a regenerative option, yet their combined synergistic efficacy remains unclear. This randomized controlled trial investigates the synergistic effect of PDRN combined with EMSE and ESWT. Forty-eight patients with chronic LE were randomly allocated to receive EMSE and ESWT plus either a 3 mL saline (Group 1) or a 3 mL PDRN (5.625 mg/3 mL) injection at the common extensor tendon origin (Group 2). Functional outcomes, including visual analog scale of pain, Mayo elbow performance score (MEPS), and hand grip strength index (HGSI), along with ultrasonographic findings, were evaluated at baseline, 6, and 12 weeks. Both groups demonstrated overall post-treatment improvements. However, at 6 weeks, Group 2 exhibited significantly greater increases in MEPS ( p = 0.002) and common extensor tendon depth (CETD, p = 0.003), alongside a greater decrease in color Doppler activity ( p = 0.001) than Group 1. At 12 weeks, Group 2 maintained significantly superior improvements in CETD ( p = 0.008) and HGSI ( p = 0.035). These findings highlight the potential of PDRN as an effective adjunctive therapy to enhance the clinical and structural outcomes of EMSE and ESWT in chronic LE. Registry : ClinicalTrials.gov, TRN: NCT06753630, Registration date: 02/12/2024.