Abstract
ObjectiveTo compare the effectiveness of platelet‐rich plasma (PRP), autologous blood (AB), and corticosteroid injections in patients with lateral epicondylitis.Type of StudyNetwork meta‐analysis.Literature SurveyRandomized controlled trials (RCTs) that compared any two forms of injections among PRP, AB, and corticosteroid for the treatment of lateral epicondylitis were searched from inception to 30 November 2018, on PubMed, Embase, and Cochrane library.MethodologyTwo researchers independently selected and assessed the quality of RCTs with the Cochrane Risk of Bias Tool. All relevant data from the included studies were extracted and heterogeneity was checked by Cochran's Q test and inconsistency statistic (I2). Publication bias was evaluated by constructing contour‐enhanced funnel plots. Stata 15 software was applied for pairwise meta‐analysis and network meta‐analysis. To explore the efficacy between different follow‐up periods, we considered the duration within 2 months to be short term, whereas 2 months or more was considered long term.SynthesisTwenty RCTs (n = 1271) were included in this network meta‐analysis. According to ranking probabilities, corticosteroid ranked first for visual analog score (VAS) (surface under the cumulative ranking [SUCRA] = 90.7), modified Nirschl score (82.9), maximum grip strength (69.5), modified Mayo score (MMS) (77.9), and Patient‐Related Tennis Elbow Evaluation (PRTEE) score (93.3) for the short‐term period. For the long‐term period, PRP ranked first for VAS (94.3), pressure pain threshold (99.8), Disabilities of Arm Shoulder and Hand (DASH) score (75.2), MMS (88.2), and the PRTEE score (81.8).ConclusionPRP was associated with more improvement in pain intensity and function in the long term than were the comparators. However, in the short term, corticosteroids were associated with the most improvement.
Highlights
Lateral epicondylitis (LE), called tennis elbow, is one of the most prevalent upper extremity tendinous disorders
LE was previously regarded as an inflammatory process; recent histopathological studies have demonstrated that the focal site had a paucity of inflammatory cells
At 2 months or more follow-up, platelet-rich plasma (PRP) was associated with significantly lower pain scores than corticosteroids (UMD, −2.850; 95% confidence interval (CI), −4.907 to −0.794; P = .007) and autologous blood (AB) (UMD, −0.747; 95% CI, −1.292 to −0.203; P = .007); AB was associated with significantly better changes in pain intensity than corticosteroids (UMD, 1.013; 95% CI, 0.681 to 1.345; P < .001); PRP was associated with significantly higher pressure pain threshold (PPT) (UMD, 4.400; 95% CI, 1.387 to 7.413; P = .004) than AB, and AB was superior to corticosteroids in increasing PPT (UMD, 9.900; 95% CI, 5.593 to 14.207; P < .001)
Summary
Lateral epicondylitis (LE), called tennis elbow, is one of the most prevalent upper extremity tendinous disorders. A population study published in 2015 showed that the prevalence of LE in the general population ranged from 1% to 3% and peaked in the fifth decade without gender-based differences.[1] The cause of LE remains unclear. Patients with LE experience pain and lose elbow function. LE was previously regarded as an inflammatory process; recent histopathological studies have demonstrated that the focal site had a paucity of inflammatory cells. LE should be considered as tendinosis due to degenerative process of the tendon.[5] It has been reported that some patients gained benefits from surgical
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