Platelet-rich plasma versus autologous blood versus steroid injection in lateral epicondylitis: systematic review and network meta-analysis

Abstract

BackgroundClinical outcomes between the use of platelet-rich plasma (PRP), autologous blood (AB) and corticosteroid (CS) injection in lateral epicondylitis are still controversial.Materials and methodsA systematic review and network meta-analysis of randomized controlled trials was conducted with the aim of comparing relevant clinical outcomes between the use of PRP, AB and CS injection. Medline and Scopus databases were searched from inception to January 2015. A network meta-analysis was performed by applying weight regression for continuous outcomes and a mixed-effect Poisson regression for dichotomous outcomes.ResultsTen of 374 identified studies were eligible. When compared to CS, AB injection showed significantly improved effects with unstandardized mean differences (UMD) in pain visual analog scale (VAS), Disabilities of Arm Shoulder and Hand (DASH), Patient-Related Tennis Elbow Evaluation (PRTEE) score and pressure pain threshold (PPT) of −2.5 (95 % confidence interval, −3.5, −1.5), −25.5 (−33.8, −17.2), −5.3 (−9.1, −1.6) and 9.9 (5.6, 14.2), respectively. PRP injections also showed significantly improved VAS and DASH scores when compared with CS. PRP showed significantly better VAS with UMD when compared to AB injection. AB injection has a higher risk of adverse effects, with a relative risk of 1.78 (1.00, 3.17), when compared to CS. The network meta-analysis suggested no statistically significant difference in multiple active treatment comparisons of VAS, DASH and PRTEE when comparing PRP and AB injections. However, AB injection had improved DASH score and PPT when compared with PRP injection. In terms of adverse effects, AB injection had a higher risk than PRP injection.ConclusionsThis network meta-analysis provided additional information that PRP injection can improve pain and lower the risk of complications, whereas AB injection can improve pain, disabilities scores and pressure pain threshold but has a higher risk of complications.Level of evidenceLevel I evidence

Arthroscopic Debridement Versus Platelet-Rich Plasma Injection: A Prospective, Randomized, Comparative Study of Chronic Lateral Epicondylitis With a Nearly 2-Year Follow-Up

“…According to a network meta-analysis comparing PRP, corticosteroid, and AB injection, published in 2015, PRP improves pain and reduces the risk of complications, whereas AB improves pain, disability scores, and the pressure pain threshold but involves a higher risk of complications. 42 Nevertheless, Krogh and colleagues found that even though AB and PRP were significantly superior to placebo, only 1 trial was at low risk of bias. 18 The poor clinical outcomes found at 2 years in our study are consistent with other research findings showing that PRP is not effective in long-term pain reduction compared with steroid and placebo injection.…”

Platelet‐Rich Plasma Vs Autologous Blood Vs Corticosteroid Injections in the Treatment of Lateral Epicondylitis: A Systematic Review, Pairwise and Network Meta‐Analysis of Randomized Controlled Trials

“…The cause of LE remains unclear. However, there is a common agreement that LE might be caused by repetitive strain to the extensor tendon, typically the extensor carpi radialis brevis tendon, and by overuse of the wrist. Patients with LE experience pain and lose elbow function.…”

Efficacy of platelet-rich plasma injections for symptomatic tendinopathy: systematic review and meta-analysis of randomised injection-controlled trials

“…Previous meta-analyses have drawn disparate conclusions regarding PRP efficacy, likely because of widely varying methodologies among studies. [32][33][34][35][36][37][38] We designed the current review to minimise potential sources of bias, namely by excluding non-randomised studies, studies with non-injection control groups, or active injectable controls (eg, whole blood, PRP). Still, we identified significant heterogeneity in treatment effects.…”