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

Overview

Journal PM R

Publisher Wiley

Specialties Emergency Medicine
Rehabilitation Medicine

Date 2019 Nov 19

PMID 31736257

Citations 17

Authors

Siqi Tang

Xiaoshuai Wang

Peihui Wu

Peiqi Wu

Jiaming Yang

ZeFeng Du

Shaoyu Liu

Fuxin Wei

Affiliations

Soon will be listed here.

Abstract

Objective: To compare the effectiveness of platelet-rich plasma (PRP), autologous blood (AB), and corticosteroid injections in patients with lateral epicondylitis.

Type Of Study: Network meta-analysis.

Literature Survey: Randomized 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.

Methodology: Two 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 (I ). 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.

Synthesis: Twenty 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).

Conclusion: PRP 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.

Citing Articles

Comparing autologous blood, corticosteroid, and a combined injection of both for treating lateral epicondylitis: a randomized clinical trial.

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Evaluation of the efficiency of an ultrasound-supported infiltration technique in patients with tennis elbow applying the ITEC medical device: a multicenter study.

Thiele K, Unmann A, Geyer S, Siebenlist S, Scheibel M, Seemann R JSES Int. 2024; 8(2):361-370.

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Platelet-rich plasma versus corticosteroid: a randomized controlled trial on tennis elbow patients resistant to nonsurgical treatments.

Sayadi S, Shahbazi P, Najafi A, Ochi F, Jafarabady K, Rezaei M Ann Med Surg (Lond). 2023; 85(9):4385-4388.

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Nonoperative Management of Lateral Epicondyle Tendinopathy: An Umbrella Review.

Kinney W, Anderson B J Chiropr Med. 2023; 22(3):204-211.

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Comparison of the Clinical Results of Platelet-Rich Plasma, Steroid and Autologous Blood Injections in the Treatment of Chronic Lateral Epicondylitis.

Kivrak A, Ulusoy I Healthcare (Basel). 2023; 11(5).

PMID: 36900772 PMC: 10000995. DOI: 10.3390/healthcare11050767.

References

Vetrano M, Castorina A, Vulpiani M, Baldini R, Pavan A, Ferretti A . Platelet-rich plasma versus focused shock waves in the treatment of jumper's knee in athletes. Am J Sports Med. 2013; 41(4):795-803. DOI: 10.1177/0363546513475345. View

Benninger M, Walner D . Coblation: improving outcomes for children following adenotonsillectomy. Clin Cornerstone. 2007; 9 Suppl 1:S13-23. DOI: 10.1016/s1098-3597(07)80005-6. View

Mattie R, Wong J, McCormick Z, Yu S, Saltychev M, Laimi K . Percutaneous Needle Tenotomy for the Treatment of Lateral Epicondylitis: A Systematic Review of the Literature. PM R. 2016; 9(6):603-611. DOI: 10.1016/j.pmrj.2016.10.012. View

Beaton D, Katz J, Fossel A, Wright J, Tarasuk V, Bombardier C . Measuring the whole or the parts? Validity, reliability, and responsiveness of the Disabilities of the Arm, Shoulder and Hand outcome measure in different regions of the upper extremity. J Hand Ther. 2001; 14(2):128-46. View

Nirschl R, Pettrone F . Tennis elbow. The surgical treatment of lateral epicondylitis. J Bone Joint Surg Am. 1979; 61(6A):832-9. View

Gautam V, Verma S, Batra S, Bhatnagar N, Arora S . Platelet-rich plasma versus corticosteroid injection for recalcitrant lateral epicondylitis: clinical and ultrasonographic evaluation. J Orthop Surg (Hong Kong). 2015; 23(1):1-5. DOI: 10.1177/230949901502300101. View

Nadeau S, Filali M, Zhang J, Kerr B, Rivest S, Soulet D . Functional recovery after peripheral nerve injury is dependent on the pro-inflammatory cytokines IL-1β and TNF: implications for neuropathic pain. J Neurosci. 2011; 31(35):12533-42. PMC: 6703268. DOI: 10.1523/JNEUROSCI.2840-11.2011. View

Coombes B, Bisset L, Vicenzino B . Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet. 2010; 376(9754):1751-67. DOI: 10.1016/S0140-6736(10)61160-9. View

Sanders Jr T, Kremers H, Bryan A, Ransom J, Smith J, Morrey B . The epidemiology and health care burden of tennis elbow: a population-based study. Am J Sports Med. 2015; 43(5):1066-71. PMC: 4517446. DOI: 10.1177/0363546514568087. View

10.

Majewski M, Ochsner P, Liu F, Fluckiger R, Evans C . Accelerated healing of the rat Achilles tendon in response to autologous conditioned serum. Am J Sports Med. 2009; 37(11):2117-25. DOI: 10.1177/0363546509348047. View

11.

Calandruccio J, Steiner M . Autologous Blood and Platelet-Rich Plasma Injections for Treatment of Lateral Epicondylitis. Orthop Clin North Am. 2017; 48(3):351-357. DOI: 10.1016/j.ocl.2017.03.011. View

12.

Kim C, Moalem-Taylor G . Interleukin-17 contributes to neuroinflammation and neuropathic pain following peripheral nerve injury in mice. J Pain. 2010; 12(3):370-83. DOI: 10.1016/j.jpain.2010.08.003. View

13.

Oudelaar B, Peerbooms J, Veld R, Vochteloo A . Concentrations of Blood Components in Commercial Platelet-Rich Plasma Separation Systems: A Review of the Literature. Am J Sports Med. 2018; 47(2):479-487. DOI: 10.1177/0363546517746112. View

14.

Shakeel H, Ahmad T . Steroid injection versus NSAID injection for trigger finger: a comparative study of early outcomes. J Hand Surg Am. 2012; 37(7):1319-23. DOI: 10.1016/j.jhsa.2012.03.040. View

15.

Wolf J, Ozer K, Scott F, Gordon M, Williams A . Comparison of autologous blood, corticosteroid, and saline injection in the treatment of lateral epicondylitis: a prospective, randomized, controlled multicenter study. J Hand Surg Am. 2011; 36(8):1269-72. DOI: 10.1016/j.jhsa.2011.05.014. View

16.

Lindenhovius A, Henket M, Gilligan B, Lozano-Calderon S, Jupiter J, Ring D . Injection of dexamethasone versus placebo for lateral elbow pain: a prospective, double-blind, randomized clinical trial. J Hand Surg Am. 2008; 33(6):909-19. DOI: 10.1016/j.jhsa.2008.02.004. View

17.

Raeissadat S, Rayegani S, Hassanabadi H, Rahimi R, Sedighipour L, Rostami K . Is Platelet-rich plasma superior to whole blood in the management of chronic tennis elbow: one year randomized clinical trial. BMC Sports Sci Med Rehabil. 2014; 6:12. PMC: 4006635. DOI: 10.1186/2052-1847-6-12. View

18.

Khaliq A, Khan I, Inam M, Saeed M, Khan H, Iqbal M . Effectiveness of platelets rich plasma versus corticosteroids in lateral epicondylitis. J Pak Med Assoc. 2016; 65(11 Suppl 3):S100-4. View

19.

Denapoli P, Stilhano R, Ingham S, Han S, Abdalla R . Platelet-Rich Plasma in a Murine Model: Leukocytes, Growth Factors, Flt-1, and Muscle Healing. Am J Sports Med. 2016; 44(8):1962-71. DOI: 10.1177/0363546516646100. View

20.

Jindal N, Gaury Y, Banshiwal R, Lamoria R, Bachhal V . Comparison of short term results of single injection of autologous blood and steroid injection in tennis elbow: a prospective study. J Orthop Surg Res. 2013; 8:10. PMC: 3701569. DOI: 10.1186/1749-799X-8-10. View