Injection Therapy in Patients with Lateral Epicondylalgia: Hyaluronic Acid or Dextrose Prolotherapy? A Single-Blind, Randomized Clinical Trial

Effects of Hypertonic Dextrose Injection (Prolotherapy) in Lateral Elbow Tendinosis: A Systematic Review and Meta-analysis

“…Of these, 19 were excluded for the following reasons: no eligible data (n=6), duplicate (n=5), a narrative review (n=4), trial registration only (n=2), not an RCT (n=1) and conference abstract only (n=1). Finally, eight full texts met the inclusion criteria and were included for descriptive synthesis, [24][25][26][47][48][49][50][51] among which five were included in the quantitative synthesis procedure. 24-26, 50, 51 (Figure 1) Among the three that were not included in the quantitative synthesis, one study had no available data for extraction at 12-16 weeks, 52 and two studies had complex intervention components in addition toDPT.…”

“…48 In the domain of "bias due to missing outcome data," all 8 studies had low bias. [24][25][26][47][48][49][50][51] In the domain of "bias in measurement of outcome," 7 had low bias, 24-26, 47-49, 51 and 1 study had high bias. 50 In the domain "bias in selection of reported outcome", 7 had some bias, 24,26,[47][48][49][50][51] and 1 had low bias.…”

“…50 In the domain "bias in selection of reported outcome", 7 had some bias, 24,26,[47][48][49][50][51] and 1 had low bias. 25 Details of response options for signaling questions in 5 domains and overall domain were summarized in appendix 2.…”

“…In this comparison, four RCTs (n=183) were eligible for pooling. [24][25][26]51 Visual Analog Scale (VAS), numerical rating scale (NRS) were reported, with SMDs calculated in the random effect meta-analyses. Pooled results favored the use of DPT in reducing tennis elbow pain intensity compared with active control, with SMD -0.44 (95% CI -0.88 to -0.01, P =0.04) and of moderate heterogeneity (I 2 = 49%).…”

“…[19][20][21][22] Recent literature also suggests possible direct sensorineural effects of DPT on neuralgic pain. 23 The role of DPT in LET has been evaluated in a growing number of methodologically higher quality clinical trials, which reported beneficial effects on pain and function using standardized outcomes; [24][25][26] yet, the findings have not been synthesized. In a recent meta-analysis, a conclusion that injection therapy did not improve pain and functional outcomes but increased risk of adverse events in LET has been made without including DPT in the analysis.…”