Tennis Elbow: Surgery vs. Orthobiologics – A Case Study

The purpose of this case study is to examine the condition of tennis elbow (lateral epicondylitis) and compare traditional surgical treatment with a regenerative orthobiologic approach that offers an effective, minimally invasive alternative.

My name is Mark Barba, M.D. I am an orthopedic surgeon practicing in Rockford, Illinois, for 27 years. My practice is dedicated to hip and knee reconstruction and replacement, and I also specialize in orthobiologic treatments for various musculoskeletal conditions. I provide orthobiologic care to multiple sites in the body, including:

• Shoulder, elbow, and wrist
• Hip – treating arthritis, bursitis, and abductor muscle tears
• Knee – utilizing orthobiologics for multiple painful conditions including our
• Foot and ankle – treating conditions such as plantar fasciitis and Achilles tendonitis

A Typical Patient Scenario

Meet John, a 45-year-old male experiencing persistent pain on the outside of his elbow due to lateral epicondylitis (tennis elbow). Despite attempting multiple conservative treatments—bracing, massage, physical therapy, and corticosteroid injections—he has seen little relief.

Frustrated, John consults an orthopedic surgeon who offers two options:

1. Traditional surgery to remove or treat the damaged tendon, and in some cases, remove a small amount of bone.
2. An orthobiologic approach that promotes natural tendon healing through regenerative medicine.

Surgical Treatment for Tennis Elbow

Traditional surgery for tennis elbow follows these steps:

1. The patient receives a local anesthetic to numb the area.
2. A small incision is made over the lateral elbow.
3. The damaged tendon attachment is surgically treated—either through removal of degenerative tissue, thermal treatment, or, in some cases, removal of a small amount of bone.
4. The incision is closed, and the elbow is immobilized in a splint for 10–14 days.
5. After splint removal, physical therapy begins to restore strength and mobility.
6. Full healing typically takes 12 weeks.

While this approach can be effective, it requires significant downtime, structured rehabilitation, and carries surgical risks such as infection, scarring, and stiffness.

Orthobiologic Approach: A Natural Healing Alternative

Instead of surgery, John considers an orthobiologic treatment, leveraging the body’s own healing mechanisms. The process involves:

1. A small amount of fat is harvested from John’s flank via a minimally invasive technique through a tiny incision, collecting the fat in a syringe.
2. 60cc of blood is drawn and processed in a centrifuge to concentrate platelet-rich plasma (PRP).
3. Using ultrasound guidance, the damaged elbow tendon is precisely identified.
4. A combination of the patient’s own fat and PRP is injected directly into the affected area to stimulate healing.
5. The patient returns home the same day with minimal restrictions.

Recovery and Expected Results

• Soreness may last up to 72 hours, but no splinting or extensive rehab is required.
• Patients begin noticing improvement around 4 weeks.
• Most patients return to full activity within 6 weeks, as symptoms allow.
• This approach boasts a 90% or greater success rate, promoting true tendon healing rather than removing or altering tissue through surgery.

Why Choose Orthobiologics?

Compared to surgery, orthobiologic treatment offers several key benefits:

✔ Minimally invasive – No large incisions or prolonged downtime.

✔ Faster recovery – Return to activity sooner, with little to no physical therapy.

✔ Natural healing – Repairs the damaged tendon rather than removing or thermally treating it.

✔ Reduced risk – Avoids surgical complications such as infection, scarring, and stiffness.

This treatment is not covered by most health plans, however, for patients like John, orthobiologics provide a highly effective alternative to surgery—delivering excellent outcomes with fewer risks and a quicker return to daily activities.