{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T07:56:13Z","timestamp":1778226973113,"version":"3.51.4"},"reference-count":35,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2022,9,20]],"date-time":"2022-09-20T00:00:00Z","timestamp":1663632000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Lateral elbow tendinopathy (LET) is a common painful musculoskeletal disorder. Several treatments have been proposed to provide pain reduction and functional recovery, including laser therapy, hyaluronic acid peritendinous injection (Hy-A), and therapeutic exercise (TE). Our study aims to assess the effectiveness of a combined approach with high-intensity laser therapy (HILT) and Hy-A injections compared to TE on pain, muscle strength, and disability in patients with painful LET. A retrospective longitudinal study was carried out by consulting the medical records of patients with a diagnosis of painful LET formulated by clinical and instrumental findings that received functional evaluations, including the Patient-Rated Tennis Elbow Evaluation (PRTEE) and muscle strength measurement at least four times: T0 (\u201cbaseline\u201d), 1-month (T1), 3-month (T2), and 6-month follow-ups (T3). Medical records of 80 patients were analyzed. In the HILT + HyA group, the Peak-strength (p &lt; 0.001) and mean strength (p &lt; 0.001) significantly increased compared to the TE group between study times. For the PRTEE-total-score as for the subscales, the HILT + HyA group reported statistically significant reductions only for the comparisons of baseline versus T1 and baseline versus T2. No serious adverse events occurred. Our findings suggest that Hy-A associated with HILT might be more effective than TE for people with LET in the short\u2013medium term.<\/jats:p>","DOI":"10.3390\/jcm11195492","type":"journal-article","created":{"date-parts":[[2022,9,20]],"date-time":"2022-09-20T04:28:55Z","timestamp":1663648135000},"page":"5492","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Effectiveness of High-Intensity Laser Therapy Plus Ultrasound-Guided Peritendinous Hyaluronic Acid Compared to Therapeutic Exercise for Patients with Lateral Elbow Tendinopathy"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5874-0376","authenticated-orcid":false,"given":"Raffaello","family":"Pellegrino","sequence":"first","affiliation":[{"name":"Department of Scientific Research, Campus Ludes, Off-Campus Semmelweis University, 6912 Lugano, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Teresa","family":"Paolucci","sequence":"additional","affiliation":[{"name":"Physical Medicine and Rehabilitation, Department of Oral Medical Science and Biotechnology, \u201cG d\u2019Annunzio\u201d University Chieti-Pescara, 66100 Chieti, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8950-8203","authenticated-orcid":false,"given":"Fabrizio","family":"Brindisino","sequence":"additional","affiliation":[{"name":"Department of Medicine and Health Science \u201cVincenzo Tiberio\u201d, University of Molise c\/o Cardarelli Hospital, C\/da Tappino, 86100 Campobasso, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paolo","family":"Mondardini","sequence":"additional","affiliation":[{"name":"Department of Sport Science, 40100 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2899-146X","authenticated-orcid":false,"given":"Angelo","family":"Di Iorio","sequence":"additional","affiliation":[{"name":"Department of Innovative Technologies in Medicine & Dentistry, \u201cG. d\u2019Annunzio\u201d University Chieti-Pescara, 66100 Chieti, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4598-2891","authenticated-orcid":false,"given":"Antimo","family":"Moretti","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Specialties and Dentistry, University of Campania \u201cLuigi Vanvitelli\u201d, 80138 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0976-925X","authenticated-orcid":false,"given":"Giovanni","family":"Iolascon","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Specialties and Dentistry, University of Campania \u201cLuigi Vanvitelli\u201d, 80138 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,9,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/j.jor.2019.08.005","article-title":"Tennis elbow: A clinical review article","volume":"17","author":"Cutts","year":"2019","journal-title":"J. Orthop."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1681","DOI":"10.1002\/acr.22874","article-title":"Lateral Epicondylitis and Physical Exposure at Work? A Review of Prospective Studies and Meta-Analysis","volume":"68","author":"Descatha","year":"2016","journal-title":"Arthritis Care Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"23259671221078586","DOI":"10.1177\/23259671221078586","article-title":"Hand-Grip Strength and Return to Heavy Manual Work at a Mean 5-Year Follow-up After Arthroscopic Release of Recalcitrant Lateral Epicondylitis","volume":"10","author":"Fahmy","year":"2022","journal-title":"Orthop. J. Sport. Med"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1016\/j.jcot.2021.05.021","article-title":"Common tendinopathies around the elbow; what does current evidence say?","volume":"19","author":"Kheiran","year":"2021","journal-title":"J. Clin. Orthop. Trauma"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"354","DOI":"10.5312\/wjo.v13.i4.354","article-title":"Lateral epicondylitis: New trends and challenges in treatment","volume":"13","author":"Karabinov","year":"2022","journal-title":"World J. Orthop."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1097\/00042752-199404000-00004","article-title":"Assessing valid change over time in patients with lateral epicondylitis at the elbow","volume":"4","author":"Stratford","year":"1994","journal-title":"Clin. J. Sport Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1097\/CORR.0000000000002058","article-title":"Persistent Tennis Elbow Symptoms Have Little Prognostic Value: A Systematic Review and Meta-analysis","volume":"480","author":"Ikonen","year":"2022","journal-title":"Clin. Orthop. Relat. Res"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"3019","DOI":"10.1177\/0363546518801914","article-title":"Comparative Efficacy and Safety of Nonsurgical Treatment Options for Enthesopathy of the Extensor Carpi Radialis Brevis: A Systematic Review and Meta-analysis of Randomized Placebo-Controlled Trials","volume":"47","author":"Lian","year":"2019","journal-title":"Am. J. Sports Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"977","DOI":"10.3233\/BMR-210310","article-title":"Ultrasound-guided platelet-rich-plasma injections for reducing sacroiliac joint pain: A paradigmatic case report and literature review","volume":"35","author":"Lippi","year":"2022","journal-title":"J. Back Musculoskelet. Rehabil."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1066","DOI":"10.1177\/0363546514568087","article-title":"The epidemiology and health care burden of tennis elbow: A population-based study","volume":"43","author":"Sanders","year":"2015","journal-title":"Am. J. Sports Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"463","DOI":"10.3233\/BMR-210053","article-title":"Physiotherapy treatment of lateral epicondylitis: A systematic review","volume":"35","year":"2022","journal-title":"J. Back Musculoskelet. Rehabil."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"488","DOI":"10.23736\/S1973-9087.19.05280-8","article-title":"Comparison of the effects of short-duration wrist joint splinting combined with physical therapy and physical therapy alone on the management of patients with lateral epicondylitis","volume":"55","author":"Kachanathu","year":"2019","journal-title":"Eur. J. Phys. Rehabil. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.physio.2021.03.011","article-title":"Effects of low-level and high-intensity laser therapy as adjunctive to rehabilitation exercise on pain, stiffness and function in knee osteoarthritis: A systematic review and meta-analysis","volume":"114","author":"Ahmad","year":"2022","journal-title":"Physiotherapy"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.23736\/S0022-4707.22.13924-1","article-title":"Combined ultrasound guided peritendinous hyaluronic acid (500\u2013730 Kda) injection with extracorporeal shock waves therapy vs. extracorporeal shock waves therapy-only in the treatment of shoulder pain due to rotator cuff tendinopathy. A randomized clinical","volume":"62","author":"Pellegrino","year":"2022","journal-title":"J. Sports Med. Phys. Fitness"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1007\/s00266-019-01393-7","article-title":"Concomitant Use of Hyaluronic Acid and Laserin Facial Rejuvenation","volume":"43","year":"2019","journal-title":"Aesthetic Plast. Surg"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Oliva, F., Marsilio, E., Asparago, G., Frizziero, A., Berardi, A.C., and Maffulli, N. (2021). The Impact of Hyaluronic Acid on Tendon Physiology and Its Clinical Application in Tendinopathies. Cells, 10.","DOI":"10.3390\/cells10113081"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.3390\/medicina57101088","article-title":"The Role of Hyaluronic Acid in Sport-Related Tendinopathies: A Narrative Review","volume":"57","author":"Crimaldi","year":"2021","journal-title":"Medicina"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"31","DOI":"10.4103\/sja.SJA_543_18","article-title":"The STROBE guidelines","volume":"13","author":"Cuschieri","year":"2019","journal-title":"Saudi J. Anaesth."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Karanasios, S., Korakakis, V., Moutzouri, M., Drakonaki, E., Koci, K., Pantazopoulou, V., Tsepis, E., and Gioftsos, G. (2021). Diagnostic accuracy of examination tests for lateral elbow tendinopathy (LET)\u2014A systematic review. J. Hand Ther., in press.","DOI":"10.1016\/j.jht.2021.02.002"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.2522\/ptj.20110398","article-title":"Cross-cultural adaptation and measurement properties of the italian version of the Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire","volume":"92","author":"Cacchio","year":"2012","journal-title":"Phys. Ther."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1007\/BF01719664","article-title":"Drug data coding and analysis in epidemiologic studies","volume":"10","author":"Pahor","year":"1994","journal-title":"Eur. J. Epidemiol."},{"key":"ref_22","unstructured":"Stroup, W.W. (2013). Generalized Linear Mixed Models Modern Concepts, Methods and Applications, Taylor & Francis Group."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"323","DOI":"10.2307\/1165280","article-title":"Using SAS PROC MIXED to Fit Multilevel Models, Hierarchical Models, and Individual Growth Models","volume":"23","author":"Singer","year":"1998","journal-title":"J. Educ. Behav. Stat."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s41572-020-00234-1","article-title":"Tendinopathy","volume":"7","author":"Millar","year":"2021","journal-title":"Nat. Rev. Dis. Prim."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"43","DOI":"10.3389\/fnagi.2016.00043","article-title":"The Role of Detraining in Tendon Mechanobiology","volume":"8","author":"Frizziero","year":"2016","journal-title":"Front. Aging Neurosci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1136\/bjsports-2020-102525","article-title":"Exercise interventions in lateral elbow tendinopathy have better outcomes than passive interventions, but the effects are small: A systematic review and meta-analysis of 2123 subjects in 30 trials","volume":"55","author":"Karanasios","year":"2021","journal-title":"Br. J. Sports Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.jht.2020.02.002","article-title":"Effectiveness of eccentric strengthening in the treatment of lateral elbow tendinopathy: A systematic review with meta-analysis","volume":"34","author":"Chen","year":"2021","journal-title":"J. Hand Ther."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1016\/j.math.2010.03.003","article-title":"Pain biology education and exercise classes compared to pain biology education alone for individuals with chronic low back pain: A pilot randomised controlled trial","volume":"15","author":"Ryan","year":"2010","journal-title":"Man. Ther."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Yoon, S.Y., Kim, Y.W., Shin, I.S., Kang, S., Moon, H.I., and Lee, S.C. (2021). The Beneficial Effects of Eccentric Exercise in the Management of Lateral Elbow Tendinopathy: A Systematic Review and Meta-Analysis. J. Clin. Med., 10.","DOI":"10.3390\/jcm10173968"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1186\/s10195-021-00608-5","article-title":"Even experts cannot agree on the optimal use of platelet-rich plasma in lateral elbow tendinopathy: An international Delphi study","volume":"22","author":"Evans","year":"2021","journal-title":"J. Orthop. Traumatol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1032","DOI":"10.1002\/jor.20558","article-title":"Hyaluronic acid inhibits mRNA expression of proinflammatory cytokines and cyclooxygenase-2\/prostaglandin E(2) production via CD44 in interleukin-1-stimulated subacromial synovial fibroblasts from patients with rotator cuff disease","volume":"26","author":"Mitsui","year":"2008","journal-title":"J. Orthop. Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"188","DOI":"10.15406\/mojor.2015.02.00068","article-title":"The Use of Low Level Laser Therapy (LLLT) For Musculoskeletal Pain","volume":"2","author":"Cotler","year":"2015","journal-title":"MOJ Orthop. Rheumatol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"174","DOI":"10.5978\/islsm.27_18-OR-16","article-title":"Effectiveness of Low Level Laser Therapy (LLLT) in the treatment of Lateral elbow tendinopathy (LET): An umbrella review","volume":"27","author":"Mamais","year":"2018","journal-title":"Laser Ther."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1007\/s10103-015-1716-7","article-title":"Effectiveness of high-intensity laser therapy and splinting in lateral epicondylitis: A prospective, randomized, controlled study","volume":"30","author":"Dundar","year":"2015","journal-title":"Lasers Med. Sci."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1007\/s10103-015-1841-3","article-title":"Long term effects of high intensity laser therapy in lateral epicondylitis patients","volume":"31","author":"Akkurt","year":"2016","journal-title":"Lasers Med. Sci."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/19\/5492\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:34:48Z","timestamp":1760142888000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/19\/5492"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,20]]},"references-count":35,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2022,10]]}},"alternative-id":["jcm11195492"],"URL":"https:\/\/doi.org\/10.3390\/jcm11195492","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,20]]}}}