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
Highlights
Lateral epicondylitis is the most commonly diagnosed condition of the elbow [21], with a prevalence of 1–3 % in the general population [34]
The results showed that autologous blood (AB), platelet-rich plasma (PRP) and corticosteroids were more efficacious than placebo [estimated by standardized mean difference (SMD)]; there were no reports comparing the efficacy of PRP versus AB, PRP versus corticosteroids and AB versus corticosteroids
The result of the present study was that PRP injection significantly improves pain and Patient-Related Tennis Elbow Evaluation (PRTEE) score when compared with AB injection and steroid injection
Summary
Lateral epicondylitis is the most commonly diagnosed condition of the elbow [21], with a prevalence of 1–3 % in the general population [34]. Ahmad et al [1] showed that PRP was more efficacious than blood injection in terms of non-response rate and conversion to surgery rates as well as pain visual analog score (VAS), and that PRP was more efficacious than corticosteroid injections in terms of pain and Disabilities of the Arm, Shoulder and Hand (DASH) score in only one of three studies, but two other studies showed no clinically significant difference These meta-analyses included too few studies for pooling of the outcomes, utilized standardized mean difference, and lacked proper methodological quality required for performing a network meta-analysis. Clinical outcomes between the use of platelet-rich plasma (PRP), autologous blood (AB) and corticosteroid (CS) injection in lateral epicondylitis are still controversial.
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