Platelet-rich plasma therapy ensures pain reduction in the management of lateral epicondylitis – a PRISMA-compliant network meta-analysis of randomized controlled trials

ABSTRACT

Objectives

Analyze the effectiveness of PRP therapy in comparison to other available treatments in the management of lateral epicondylitis (LE).

Materials and methods

We conducted electronic database searches in PubMed, Embase, Web of Science, and Cochrane Library until June 2021 for RCTs analyzing the efficacy of PRP in the management of LE. VAS for pain, DASH score, and PRETEE score were the outcomes analyzed. The analysis was performed in R-platform using MetaInsight and interventions were ranked based on p-score approach. Cochrane’s CINeMA approach was used for quality appraisal.

Results

Twenty-five RCTs with 2040 patients were included in the network analysis. Compared to saline control, only leukocyte-rich-PRP resulted in significant pain relief (WMD=−14.8,95% CI [−23.18,-6.39];low confidence) compared to steroid, local anesthetic, laser, and surgery. On analyzing DASH scores and PRETEE scores, none of the above-mentioned treatment methods were superior to saline control. In subgroup analysis, leucocyte-rich-PRP resulted in clinically significant improvement. Leucocyte-rich-PRP seems more promising with p-score of 0.415.

Conclusion

PRP therapy offers significant pain relief compared to saline control in the management of LE without similar improvement in functional outcome. With available low-quality evidence, PRP was the most promising therapy that needs further exploration to explore its usefulness in lateral epicondylitis.

KEYWORDS:

• Lateral epicondylitis
• platelet-rich plasma
• DASH
• meta-analysis
• VAS

Author contributions

Conception and design: Sathish Muthu, Madhan Jeyaraman, Sandeep Patel; Administrative support: Karthika Hathwar KS, Vijendra Yadav; Provision of study materials or patients: Madhan Jeyaraman, Sathish Muthu; Collection and assembly of data: Sandeep Patel, Ashwin Gobbur, Sandesh C Patil; Data analysis and interpretation: Madhan Jeyaraman, Sathish Muthu; Manuscript writing: All authors; and Final approval of manuscript: All authors.

Declaration of interests

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Supplementary material

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Additional information

Funding

This paper is not funded.