Comparison of Autologous Blood, Corticosteroid, and Saline Injection in the Treatment of Lateral Epicondylitis: A Prospective, Randomized, Controlled Multicenter Study

Wolf, Jennifer Moriatis; Özer, Kağan; Scott, Frank A.; Gordon, Michael J.; Williams, Allison

doi:10.1016/j.jhsa.2011.05.014

Cited by 128 publications

(101 citation statements)

References 12 publications

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“…18,[167][168][169][170][172][173][174][175][176][177][178][179][180][181][182][183][184][185][188][189][190][191][192][193][194][195][196][197][198] The majority of studies had small sample sizes (≤ 50 participants, n = 18; 51-100 participants, n = 15; > 100 participants, n = 3).…”

Section: Randomised Controlled Trials Not Included In An Existing Sysmentioning

confidence: 99%

“…However, given the need to update the systematic reviews on which these findings are based, 56,60 and the subsequent publication of 10 new RCTs, 165,168,169,173,176,181,183,184,191,193 the overall level of evidence, as determined using the GRADE principles, is low (see Table 24). All of the subsequent RCTs were head-to-head comparisons, and all but one study (Gosens et al,…”

Section: Glucocorticoid Injectionsmentioning

confidence: 99%

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What is the clinical effectiveness and cost-effectiveness of conservative interventions for tendinopathy? An overview of systematic reviews of clinical effectiveness and systematic review of economic evaluations

Long

Briscoe

Cooper

et al. 2015

Health Technology Assessment

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BackgroundLateral elbow tendinopathy (LET) is a common complaint causing characteristic pain in the lateral elbow and upper forearm, and tenderness of the forearm extensor muscles. It is thought to be an overuse injury and can have a major impact on the patient’s social and professional life. The condition is challenging to treat and prone to recurrent episodes. The average duration of a typical episode ranges from 6 to 24 months, with most (89%) reporting recovery by 1 year.ObjectivesThis systematic review aims to summarise the evidence concerning the clinical effectiveness and cost-effectiveness of conservative interventions for LET.Data sourcesA comprehensive search was conducted from database inception to 2012 in a range of databases including MEDLINE, EMBASE and Cochrane Databases.Methods and outcomesWe conducted an overview of systematic reviews to summarise the current evidence concerning the clinical effectiveness and a systematic review for the cost-effectiveness of conservative interventions for LET. We identified additional randomised controlled trials (RCTs) that could contribute further evidence to existing systematic reviews. We searched MEDLINE, EMBASE, Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, Web of Science, The Cochrane Library and other important databases from inception to January 2013.ResultsA total of 29 systematic reviews published since 2003 matched our inclusion criteria. These were quality appraised using the Assessment of Multiple Systematic Reviews (AMSTAR) checklist; five were considered high quality and evaluated using a Grading of Recommendations, Assessment, Development and Evaluation approach. A total of 36 RCTs were identified that were not included in a systematic review and 29 RCTs were identified that had only been evaluated in an included systematic review of intermediate/low quality. These were then mapped to existing systematic reviews where further evidence could provide updates. Two economic evaluations were identified.LimitationsThe summary of findings from the review was based only on high-quality evidence (scoring of > 5 AMSTAR). Other limitations were that identified RCTs were not quality appraised and dichotomous outcomes were also not considered. Economic evaluations took effectiveness estimates from trials that had small sample sizes leading to uncertainty surrounding the effect sizes reported. This, in turn, led to uncertainty of the reported cost-effectiveness and, as such, no robust recommendations could be made in this respect.ConclusionsClinical effectiveness evidence from the high-quality systematic reviews identified in this overview continues to suggest uncertainty as to the effectiveness of many conservative interventions for the treatment of LET. Although new RCT evidence has been identified with either placebo or active controls, there is uncertainty as to the size of effects reported within them because of the small sample size. Conclusions regarding cost-effectiveness are also unclear. We consider that, although updated or new systematic reviews may also be of value, the primary focus of future work should be on conducting large-scale, good-quality clinical trials using a core set of outcome measures (for defined time points) and appropriate follow-up. Subgroup analysis of existing RCT data may be beneficial to ascertain whether or not certain patient groups are more likely to respond to treatments.Study registrationThis study is registered as PROSPERO CRD42013003593.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Randomised Controlled Trials Not Included In An Existing Sysmentioning

confidence: 99%

Section: Glucocorticoid Injectionsmentioning

confidence: 99%

What is the clinical effectiveness and cost-effectiveness of conservative interventions for tendinopathy? An overview of systematic reviews of clinical effectiveness and systematic review of economic evaluations

Long

Briscoe

Cooper

et al. 2015

Health Technology Assessment

View full text Add to dashboard Cite

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“…However, studies that compare the results of autologous of blood injection for lateral epicondylitis with or without ultrasonography guidance do not exist. In contrast to the literature, Wolf et al (8) found no additional benefit of autologous blood injection over corticosteroid or saline injection and stated that tendinopathy of extensor carpi radialis brevis origin is self-limited. Since lateral epicondylitis may be self-limited in some patients, we performed the study in a cohort consisting of recalcitrant cases and thus ruled out the possibility of self-limitation.…”

Section: Discussionmentioning

confidence: 92%

“…In addition, the existing studies do not reveal any intermediate or long-term results (8)(9)(10)(11)(12)(13)(14). Recalcitrant cases can be treated with surgical procedures.…”

mentioning

confidence: 99%

Autologous Blood Injection Works for Recalcitrant Lateral Epicondylitis

et al. 2016

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Background: Recalcitrant lateral epicondylitis may be a disabling condition. Treatment of this condition is still controversial. Aims: In the present prospective study, we evaluated the long-term results of autologous blood injection for the treatment of recalcitrant lateral epicondylitis. Study Design: Prospective clinical study. Methods: A total of 42 elbows of 40 consecutive patients (28 female, 12 male) were enrolled in this prospective study. Seven patients left the study (3 patients moved to another city, 1 patient died in the second week due to a heart condition, 1 patient quit the study because of the resolution of pain in the fourth week and 2 patients did not agree to the second injection). Thirteen patients were lost to third year follow-up.Therefore, a total of 21 elbows of 20 patients with 3 years of follow-up were included in this study. The mean age of the patients was 47.25 years (range, 20-68 years). Results: Visual analogue scale (VAS), Nirschl score and grip strength were significantly improved after injections when compared to before treatment. The best improvement in terms of grip strength, Nirschl score and VAS score was detected at the one year follow-up. The improvement in Nirschl and VAS score sustained until the third year. Conclusion: We suggest that autologous blood injection for the treatment of recalcitrant lateral epicondylitis is an effective, safe and successful procedure in the long-term.

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“…Conservative management includes using non-steroidal anti-inflammatorys (NSAIDs) and corticosteroid injections however their long-term effectiveness has been questioned. 19 Corticosteroid injections have been known to cause skin atrophy, skin depigmentation and fatty atrophy. Three injections within a single year are considered a maximum after which surgical procedures are normally considered.…”

Section: Introductionmentioning

confidence: 99%

The effect of platelet-rich plasma injection on lateral epicondylitis following failed conservative management

Brkljac

Kumar

Kalloo

et al. 2015

Journal of Orthopaedics

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Comparison of Autologous Blood, Corticosteroid, and Saline Injection in the Treatment of Lateral Epicondylitis: A Prospective, Randomized, Controlled Multicenter Study

Cited by 128 publications

References 12 publications

What is the clinical effectiveness and cost-effectiveness of conservative interventions for tendinopathy? An overview of systematic reviews of clinical effectiveness and systematic review of economic evaluations

What is the clinical effectiveness and cost-effectiveness of conservative interventions for tendinopathy? An overview of systematic reviews of clinical effectiveness and systematic review of economic evaluations

Autologous Blood Injection Works for Recalcitrant Lateral Epicondylitis

The effect of platelet-rich plasma injection on lateral epicondylitis following failed conservative management

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