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

Tang, Siqi; Wang, Xiaoshuai; Wu, Peiqi; Yang, Jiaming; Du, Zefeng; Liu, Shaoyu; Wei, Fuxin

doi:10.1002/pmrj.12287

Cited by 37 publications

(25 citation statements)

References 66 publications

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“…Subgroup analysis was performed to explore the short-term, medium-term, and long-term effects after injection. With reference to the previous systematic reviews [ 28 , 29 ] and the recovery speed of rotator cuff lesions, [ 30 , 31 ] the post-injection follow-ups was defined as short-term (3–6 weeks), medium-term (8–12 weeks), and long-term (over 12 weeks).…”

Section: Methodsmentioning

confidence: 99%

Platelet-rich plasma injection vs corticosteroid injection for conservative treatment of rotator cuff lesions

Wang¹,

Zhang²,

Ma³

et al. 2021

Medicine

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Background: To explore the effectiveness of platelet-rich plasma (PRP) injection regarding functional recovery, pain relief, and range of motion (ROM) of shoulder compared with the corticosteroid injection in patients with rotator cuff lesions treated non-operatively. Methods: An electronic literature search was performed by 2 authors in the PubMed, Embase, Cochrane Library, and Web of Science databases to identify relevant randomized controlled trial (RCTs) that were published up to July 20, 2020. The quality of the included RCTs was evaluated using the approach recommended by the Cochrane Handbook for Systematic Reviews of Interventions. Standardized mean differences (SMDs) or mean differences (MDs) with 95% confidence intervals (CIs) were applied to calculate the pooled effect sizes. Results: Six RCTs were included in this systematic review. Meta-analysis revealed that corticosteroid injection yielded statistically significant superior functional recovery (SMD = −0.80; 95% CI, −1.42 to −0.18; P = .01) and pain relief (MD = 1.59; 95% CI, 0.30–2.89; P = .02) compared with PRP injection for rotator cuff lesions during the short-term follow-up period. However, at the medium-term and long-term follow-up, no statistically significant difference was identified between the 2 groups. Regarding the ROM of shoulder, no statistically significant difference was found between the 2 groups during the whole follow-up period. Conclusions: The current clinical evidence revealed short-term efficacy of corticosteroid injection and no significant medium- to long-term difference between corticosteroid and PRP injection in the treatment of rotator cuff lesions. Additional studies with longer follow-ups, larger sample sizes, and more rigorous designs are needed to draw more reliable and accurate conclusions.

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Section: Methodsmentioning

confidence: 99%

Platelet-rich plasma injection vs corticosteroid injection for conservative treatment of rotator cuff lesions

Wang¹,

Zhang²,

Ma³

et al. 2021

Medicine

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“…Unlike some NMA that focused on a specific injury [ 18 , 19 ], or limited their analysis to only few injections [ 20 ], this study included a wide range of conditions and injection therapies, allowing the efficacy of prolotherapy for CSTI to be generalised. Nevertheless, the efficacy of prolotherapy for specific injuries (i.e.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of prolotherapy in comparison to other therapies for chronic soft tissue injuries: A systematic review and network meta-analysis

et al. 2021

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Introduction Prolotherapy and other injections, primarily acting on pathways associated with maladaptive tissue repair, are recommended for recalcitrant chronic soft tissue injuries (CSTI). However, selection of injection is challenging due to mixed results. This network meta-analysis (NMA) aimed to compare prolotherapy with other therapies, particularly injections, for CSTI and establish robustness of the results. Methodology Pubmed, Medline, SPORTDiscus and Google scholar were searched from inception to 4th January 2021 for randomised controlled trials (RCTs) involving injection therapies (e.g. blood derivatives, corticosteroid, hyaluronic acid, botulinum toxin) for CSTI. The primary and secondary outcomes were pain and function, respectively, at (or nearest to) 6 months. Effect size (ES) was presented as standardised mean difference with 95% confidence interval (CI). Frequentist random effect NMA was used to generate the overall estimates, subgroup estimates (by region and measurement time point) and sensitivity analyses. Results A total of 91 articles (87 RCTs; 5859 participants) involving upper limb (74%), lower limb (23%) and truncal/hip (3%) injuries were included. At all time points, prolotherapy had no statistically significant pain benefits over other therapies. This observation remained unchanged when tested under various assumptions and with exclusion of studies with high risk of bias. Although prolotherapy did not offer statistically significant functional improvement compared to most therapies, its ES was consistently better than non-injections and corticosteroid injection for both outcomes. At selected time points and for selected injuries, prolotherapy demonstrated potentially better pain improvement over placebo (<4 months: shoulder [ES 0.65; 95% CI 0.00 to 1.30]; 4–8 months: elbow [ES 0.91; 95% CI 0.12 to 1.70]; >8 months: shoulder [ES 2.08; 95% CI 1.49, to 2.68]). Injections generally produced greater ES when combined with non-injection therapy. Conclusion While clinical outcomes were generally comparable across types of injection therapy, prolotherapy may be used preferentially for selected conditions at selected times.

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“…Indeed, PRP injections have shown efficacy in some previous studies, 3,6,7 but not all studies have made similar determinations. [14][15][16]20 Likewise, previously published systematic reviews and meta-analyses comparing PRP use with other interventions for the treatment of lateral epicondylitis have reached variable conclusions. [20][21][22][23][24][25] Hardy et al also commented on the low complication rate after PRP injections.…”

Section: See Related Article On Page 3360mentioning

confidence: 99%

“…[14][15][16]20 Likewise, previously published systematic reviews and meta-analyses comparing PRP use with other interventions for the treatment of lateral epicondylitis have reached variable conclusions. [20][21][22][23][24][25] Hardy et al also commented on the low complication rate after PRP injections. In fact, no patient in any of the 3 included studies sustained a complication after either receiving a PRP injection or undergoing surgical intervention.…”

Section: See Related Article On Page 3360mentioning

confidence: 99%

Editorial Commentary: Elbow Lateral Epicondylitis Treatment Using Platelet-Rich Plasma

Field

2021

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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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

Cited by 37 publications

References 66 publications

Platelet-rich plasma injection vs corticosteroid injection for conservative treatment of rotator cuff lesions

Platelet-rich plasma injection vs corticosteroid injection for conservative treatment of rotator cuff lesions

Efficacy of prolotherapy in comparison to other therapies for chronic soft tissue injuries: A systematic review and network meta-analysis

Editorial Commentary: Elbow Lateral Epicondylitis Treatment Using Platelet-Rich Plasma

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