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Platelet-rich plasma versus autologous blood versus corticosteroid injections in the treatment of lateral epicondylitis: a systematic review, pairwise and network meta-analysis of randomized controlled trials
Tang S, Wang X, Wu P, Wu P, Yang J, Du Z, Liu S, Wei F
PM & R : the journal of injury, function, and rehabilitation. 2019
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 November 30, 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(2) ). 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 two months to be short-term, whereas two months or more was considered long-term. SYNTHESIS Twenty RCTs (n = 1,271) 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 (MNS) (82.9), maximum grip strength (MGS) (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 (PPT) (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 29 function in the long-term than the comparators. However, in the short-term, corticosteroids were associated with the most improvement. This article is protected by copyright. All rights reserved.