Clinical efficacy of platelet-rich plasma in the treatment of lateral epicondylitis: a systematic review and meta-analysis of randomized placebo-controlled clinical trials

Abstract

To compare the effects of platelet-rich plasma (PRP) injection versus placebo (saline injection) on pain and joint function in lateral epicondylitis in randomized placebo-controlled trials. Randomized controlled trials that evaluated pain (visual analog scale [VAS] and patient-rated tennis elbow evaluation [PRTEE]) and/or functional improvement (PRTEE; disability of the arm, shoulder, and hand [DASH]; and Roles–Maudsley score [RMS]) in patients diagnosed with lateral epicondylitis and compared PRP with placebo injections were considered. The MEDLINE, EMBASE, Web of Science, and Scopus databases were searched from inception to October 2019. The assessment of bias was performed using the Cochrane Risk of Bias Tool version 1. The meta-analysis was conducted with a random effects model and generic inverse variance method. Five trials involving a total of 276 individuals were included. They used a parallel study design and saline solution as placebo. The mean age of participants was 48.0 ± 9.3 years. Follow-up varied from 2 months to 1 year. No significant changes were noted for pain (standardized mean difference [SMD], − 0.51 [95% confidence interval (CI), − 1.32 to − 0.30]) nor functional scores (SMD, − 0.07 [95% CI, − 0.46 to 0.33]) between PRP and placebo injections. The most frequent adverse reaction reported in two of the five studies was transient post-injection pain for a few days (from 16 to 20% in the PRP group and from 8 to 16% in the placebo group). PRP injection was not superior to placebo for relieving pain and joint functionality in chronic lateral epicondylitis. However, patients reported improvement after both interventions in such clinical parameters. Further randomized trials are required to determine whether PRP injection is clinically more effective than placebo (saline injection).

Appendix

Example of search strategy for Clinical efficacy of platelet-rich plasma in the treatment of lateral epicondylitis: a systematic review and meta-analysis of randomized placebo-controlled clinical trials.

MEDLINE

• 1. Elbow/

• 2. exp Elbow Joint/ or exp Tennis Elbow/

• 3. (elbow or “cubital joint” or “elbow joint” or “elbow tendinopathy” or epicondylalgia or “epicondylatgia humeri” or “epicondylitis humeri” or “epicondylitis lateralis” or “epycondylitis humeri” or “external humeral epicondylitis” or “humeral epicondylitis” or “humerus epicondylitis” or “lateral elbow tendinopathy” or “lateral elbow tendinosis” or “lateral epicondylitis” or “lateral humeral epicondylitis” or “radiohumeral bursitis” or “radiohumeral epicondylitis” or “tennis arm” or (bursitis and radiohumeral) or (elbow and tennis) or (epicondylitis and “external humeral”) or (epicondylitis and radiohumeral)).mp. [mp=title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword heading word, organism supplementary concept word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms]

• 4. 1 or 2 or 3

• 5. exp Sodium Chloride/

• 6. exp Placebo/

• 7. (“sodium chloride” or alcathion or “bacteriostatic sodium chloride 0.9%” or “broncho saline” or “hypertonic lactated saline solution” or “hypertonic saline” or “hypertonic saline bath” or “hypertonic sodium chloride” or “hypertonic sodium chloride solution” or “hypotonic sodium chloride” or “hypotonic sodium chloride solution” or “natrium chloride” or “natural saline” or “normal saline” or “physiological saline” or “physiological solution” or saline or (“saline solution” and hypertonic) or salt or “sodium chloride 0.45%” or “sodium chloride 0.9%” or “sodium chloride 23.4%” or “sodium chloride 3%” or “sodium chloride 5%” or “sodium chloride solution” or sodiumchloride or “table salt” or placebo*).mp. [mp=title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword heading word, organism supplementary concept word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms]

• 8. 5 or 6 or 7

• 9. 4 and 8

• 10. Exp Platelet rich plasma/

• 11. (“Platelet Rich Plasma” or “Platelet-Rich Plasma” or “PRP” or “platelet concentrate” or “platelet derived growth factor” or “Platelet-Derived Growth Factor” or “PDGF” or “platelet gel” or “plasma rich in growth factors” or “Centrifuged blood fraction” or “Concentration of platelets”).mp. [mp=title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword heading word, organism supplementary concept word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms]

• 12. 10 or 11

• 13. 4 and 8 and 12