Platelet‐rich plasma (PRP) injection therapy for lateral elbow pain
Näytönastekatsaukset
22.6.2022
Level of evidence: B
The effectiveness of platelet-rich plasma (PRP) injection therapy for lateral elbow pain and function impairment seems to be equal to the effectiveness of saline or local anesthetic injection both in short and long term.
| Reference | Study type | Population | Intervention and comparison | Outcomes | Risk of bias |
|---|---|---|---|---|---|
| «Simental-Mendía M, Vilchez-Cavazos F, Álvarez-Villalobos N ym. Clinical efficacy of platelet-rich plasma in the treatment of lateral epicondylitis: a systematic review and meta-analysis of randomized »1 | SR/MA | RCTs with placebo control group for adults > 18 yrs with epicondylitis, minimum evolution time of 3 months, and a minimum follow-up of 2 months (5 studies, 276 patients) | PRP or any derivative (autologous conditioned plasma, plasma rich in growth factors, platelet-rich fibrin) n=153 compared with saline n=123 | Pain (VAS), patient-rated tennis elbow evaluation (PRTEE), and functional improvement (PRTEE, DASH), Roles-Maudsley score | Low/moderate |
| «Karjalainen TV, Silagy M, O'Bryan E ym. Autologous blood and platelet-rich plasma injection therapy for lateral elbow pain. Cochrane Database Syst Rev 2021;9:CD010951 »2 | SR/MA | 32 RCTs and quasi-RCTs with 2337 patients comparing autologous whole blood or PRP injection therapy to another therapy (placebo or active treatment, including non-pharmacological therapies, and comparison between PRP and autologous blood) for lateral elbow pain. Of the patients 56% were females. Mean age varied between 36 and 53 years. Duration of symptoms ranged from 1 to 22 months. | Autologous whole blood or PRP injection therapy vs. another therapy (placebo or active treatment, including non-pharmacological therapies, and comparison between PRP and autologous blood) | pain relief (≥ 30% or ≥ 50%), mean pain, mean function, treatment success, quality of life, withdrawal due to adverse events, and adverse events; the primary time point was three months | Moderate |
RCT=randomized controlled trial; SR=systematic review; MA=meta-analysis; PRP=platelet-rich plasma group
| Reference | Comments |
|---|---|
| «Simental-Mendía M, Vilchez-Cavazos F, Álvarez-Villalobos N ym. Clinical efficacy of platelet-rich plasma in the treatment of lateral epicondylitis: a systematic review and meta-analysis of randomized »1 | Low risk of bias according to random sequence generation and selective reporting. 4/5 had insufficient information about allocation concealment. One study lacked information with blinding. 4/5 had unclear risk of bias due to sponsoring from companies that develop PRP devices. When one study was excluded, (n=18+18), total mean difference was -0.06 (95% CI -0.76, 0.64) and I2 was 0. There is evidence that saline injection have relevant clinical effect on pain and functional scores. |
| «Karjalainen TV, Silagy M, O'Bryan E ym. Autologous blood and platelet-rich plasma injection therapy for lateral elbow pain. Cochrane Database Syst Rev 2021;9:CD010951 »2 | Most studies were at risk of selection, performance, and detection biases, mainly due to inadequate allocation concealment and lack of participant blinding. Pain and function analysis included 8 studies, but one study compared autologous blood with glukocorticoid or saline. Of the 7 PRP studies, 3 had saline as placebo and 4 had local anesthetic as placebo. Of the PRP studies, 3 had 3 intervention arms. In ref. 1, of the 4 studies in pain analysis, 1 were not included in ref. 2, but in the analysis of function in ref. 1, all the 3 studies were also included in ref. 2. |
Results
| Reference | Number of studies and number of patients (I/C) | Follow-up time | Standardized mean difference, (95% CI) |
|---|---|---|---|
| «Simental-Mendía M, Vilchez-Cavazos F, Álvarez-Villalobos N ym. Clinical efficacy of platelet-rich plasma in the treatment of lateral epicondylitis: a systematic review and meta-analysis of randomized »1 | 4 (135/105) | 2–12 months | SMD -0.53 (-1.32–0.27) |
| «Karjalainen TV, Silagy M, O'Bryan E ym. Autologous blood and platelet-rich plasma injection therapy for lateral elbow pain. Cochrane Database Syst Rev 2021;9:CD010951 »2 | 8 (523 tot.) 5 (241 tot.) | > 6 weeks–3 months > 6–12 months | MD -0.16 (-0.60–0.29) -0.69 (-1.78–0.39) |
I= intervention; C=comparison; CI=confidence interval
| Reference | Number of studies and number of pataients (I/C) | Follow-up time | Std mean difference IV, Random, 95% CI |
|---|---|---|---|
| «Simental-Mendía M, Vilchez-Cavazos F, Álvarez-Villalobos N ym. Clinical efficacy of platelet-rich plasma in the treatment of lateral epicondylitis: a systematic review and meta-analysis of randomized »1 | 3 (63/63) | 2–12 months | SMD -0.07 (-0.46–0.33) |
| «Karjalainen TV, Silagy M, O'Bryan E ym. Autologous blood and platelet-rich plasma injection therapy for lateral elbow pain. Cochrane Database Syst Rev 2021;9:CD010951 »2 | 8 (502 tot.) 4 (203 tot.) | > 6 weeks–3 months > 6–12 months | MD -1.86 (-4,9–1,25) -5.81 (-16.66–5.05) |
I=intervention; C=comparison; CI=confidence interval
References
- Simental-Mendía M, Vilchez-Cavazos F, Álvarez-Villalobos N ym. Clinical efficacy of platelet-rich plasma in the treatment of lateral epicondylitis: a systematic review and meta-analysis of randomized placebo-controlled clinical trials. Clin Rheumatol 2020;39:2255-2265 «PMID: 32103373»PubMed
- Karjalainen TV, Silagy M, O'Bryan E ym. Autologous blood and platelet-rich plasma injection therapy for lateral elbow pain. Cochrane Database Syst Rev 2021;9:CD010951 «PMID: 34590307»PubMed