Efficacy of platelet-rich plasma versus glucocorticoid for lateral humeral epicondylitis: a meta-analysis

doi:10.3969/j.issn.2095-4344.1021

Abstract

Abstract:

BACKGROUND: Lateral epicondylitis, a common elbow disease, is often treated with glucocorticoid, but its long-term efficacy is not ideal. Platelet-rich plasma has been used as a new method for the treatment of bone and chronic inflammation, so it is necessary to systematically evaluate and analyze the therapeutic effects of the two methods.

OBJECTIVE: To systematically review the effectiveness of platelet-rich plasma versus steroid for lateral humeral epicondylitis.

METHODS: Related randomized controlled trials about platelet-rich plasma versus glucocorticoid for epicondylitis were searched in the databases of PubMed, EMbase, the Cochrane Library, CNKI, VIP, CBM and WanFang before May 2018. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of the included studies. Then meta-analysis was performed on RevMan 5.3 software.

RESULTS AND CONCLUSION: (1) Ten randomized controlled trials involving 661 patients were included. (2) The meta-analysis results showed that, in pain relief, glucocorticoids were superior to platelet-rich plasma at 2-4 weeks (SMD=0.75, P=0.01); there was no significant difference between two groups at 6-8 weeks and 12 weeks (6-8 weeks: SMD=0.38, P=0.25; 12 weeks: SMD=-0.16, P=0.33). Platelet-rich plasma was better than glucocorticoids at 6 months and 1 year (6 months: SMD=-0.95, P < 0.000 01; 1 year: SMD=-0.83, P < 0.000 01). (3) In improving joint function, glucocorticoids were superior to platelet-rich plasma at 2-4 weeks and 6-8 weeks (2-4 weeks: SMD=0.74, P < 0.000 01; 6-8 weeks: SMD=0.46, P=0.000 5); there was no significant difference between two groups at 12 weeks (SMD=-0.24, P=0.22); platelet-rich plasma was better than glucocorticoids at 6 months and 1 year (6 months: SMD=-0.65, P=0.03; 1 year: SMD=-0.53, P=0.001). (4) These results imply that in the treatment of lateral epicondylitis, glucocorticoids can relieve pain (2-4 weeks) and improve joint function (2-8 weeks), platelet-rich plasma appears to be more effective in relieving pain and improving function in the long term (6 months to 1 year). Considering the long-term therapeutic effect of platelet-rich plasma, we recommend platelet-rich plasma as the preferred option for lateral humeral epicondylitis. Due to the limited quality of included studies, more high quality studies are needed to verify the above conclusion.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Platelet-Rich Plasma, Glucocorticoids, Humerus, Meta-Analysis, Randomized Controlled Trial, Tissue Engineering

CLC Number:

R459.1

Gong Dong, Liu Jun, Dong Chenhui, Deng Yinshuan, Zhou Yanfeng, Yang Xinle, Zhen Ping. Efficacy of platelet-rich plasma versus glucocorticoid for lateral humeral epicondylitis: a meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2018, 22(35): 5735-5740.

Figures/Tables 4

References

[1] Gregory BP, Wysocki RW, Cohen MS. Controversies in surgical management of recalcitrant enthesopathy of the extensor carpi radialis brevis. J Hand Surg. 2016;41(8):856.

[2] Calandruccio JH, Steiner MM. Autologous blood and platelet-rich plasma injections for treatment of lateral epicondylitis. Orthop Clin North Am. 2017;48(3):351.

[3] Newcomer KL, Laskowski ER, Idank DM, et al. Corticosteroid injection in early treatment of lateral epicondylitis. Clin J Sport Med. 2001;11(4): 214-222.

[4] Xu B, Goldman H. Steroid injection in lateral epicondylar pain. Aust Fam Physician. 2008;37(11):925-926.

[5] Marques LF, Stessuk T, Camargo IC, et al. Platelet-rich plasma (PRP): methodological aspects and clinical applications. Platelets. 2015;26(2): 101-113.

[6] Higgins J, Green SE. Cochrane Handbook for Systematic Reviews of Interventions Version 5. 1. 0. The Cochrane Collaboration (Eds). Naunyn-Schmiedebergs Archiv für experimentelle Pathologie und Pharmakologie. 2011;5(2):S38.

[7] Gautam VK, Verma S, Batra S, et al. Platelet-rich plasma versus corticosteroid injection for recalcitrant lateral epicondylitis: clinical and ultrasonographic evaluation. J Orthopa Surg. 2015;23(1):1-5.

[8] Gosens T, Peerbooms JC, Laar WV, et al. Ongoing positive effect of platelet-rich plasma versus corticosteroid injection in lateral epicondylitis a double-blind randomized controlled trial with 2-year Follow-up. Am J Sports Med. 2011;39(39):1200-1208.

[9] Krogh TP, Fredberg U, Stengaard-Pedersen K, et al. Treatment of lateral epicondylitis with platelet-rich plasma, glucocorticoid, or saline: a randomized, double-blind, placebo-controlled trial. Am J Sports Med. 2013;41(3):625-635.

[10] Khaliq A, Khan I, Inam M, et al. Effectiveness of platelets rich plasma versus corticosteroids in lateral epicondylitis. J Pak Med Assoc. 2015; 65(11 Suppl 3):S100-104.

[11] Lebiedziński R, Synder M, Buchcic P, et al. A randomized study of autologous conditioned plasma and steroid injections in the treatment of lateral epicondylitis. Int Orthop. 2015;39(11):2199-2203.

[12] Omar AS, Ibrahim ME, Ahmed AS, et al. Local injection of autologous platelet rich plasma and corticosteroid in treatment of lateral epicondylitis and plantar fasciitis: Randomized clinical trial. Egypt Rheumatol. 2012;34(2):43-49.

[13] Palacio PE, Ramos SR, Maiara K, et al. Effects of platelet-rich plasma on lateral epicondylitis of the elbow: prospective randomized controlled trial. Revista Brasileira De Ortopedia. 2016;51(1):90-95.

[14] Peerbooms JC, Sluimer J, Bruijn DJ, et al. Positive effect of an autologous platelet concentrate in lateral epicondylitis in a double-blind randomized controlled trial: platelet-rich plasma versus corticosteroid injection with a 1-year follow-up. Am J Sports Med. 2010;38(2):255.

[15] Seetharamaiah VB, Gantaguru A, Basavarajanna S. A comparative study to evaluate the efficacy of platelet-rich plasma and triamcinolone to treat tennis elbow. Indian J Orthop. 2017;51(3):304-311.

[16] Yadav R, Kothari SY, Borah D. Comparison of local injection of platelet rich plasma and corticosteroids in the treatment of lateral epicondylitis of humerus. J Clin Diagn Res. 2015;9(7):RC05.

[17] Coombes BK, 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):1751-1767.

[18] Judson CH, Wolf JM. Lateral Epicondylitis: review of injection therapies. Orthop Clin North Am. 2013;44(4):615-623.

[19] Mishra AK, Skrepnik NV, Edwards SG, et al. Efficacy of platelet-rich plasma for chronic tennis elbow: a double-blind, prospective, multicenter, randomized controlled trial of 230 patients. Am J Sports Med. 2014;42(2):463.

[20] Lhee SH, Kim JW, Jeon JB, et al. Prospective randomized clinical study for the treatment of lateral epicondylitis; comparison among prp (platelet-rich plasm), prolotherapy, physiotherapy and eswt. J Shoulder Elbow Surg. 2013;22(10):e30-e31.

[21] Arik HO, Kose O, Guler F, et al. Injection of autologous blood versus corticosteroid for lateral epicondylitis: a randomised controlled study. J Orthop Surg. 2014;22(3):333-337.

[22] Jindal N, Gaury Y, Banshiwal RC, et al. 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(1):1-7.

[23] Jobe FW, Ciccotti MG. Lateral and medial epicondylitis of the elbow. J Am Acad Orthop Surg. 1994;2(1):1-8.

[24] Lyras D, Kazakos K, Verettas D, et al. Immunohistochemical study of angiogenesis after local administration of platelet-rich plasma in a patellar tendon defect. Int Orthop. 2010;34(1):143-148.

[25] Tarpada SP, Morris MT, Lian J, et al. Current advances in the treatment of medial and lateral epicondylitis. J Orthop. 2018;15(1):107.