Efficacy and safety of autologous blood products compared with corticosteroid injections in the treatment of lateral epicondylitis, a meta-analysis of randomized controlled trials
Qian X, Lin Q, Wei K, Hu B, Jing P, Wang J
Pm & R : the Journal of Injury, Function, and Rehabilitation. 2016;8((8):):780-91
OBJECTIVE To compare the efficacy and safety between autologous blood products (ABPs) and corticosteroid injections (CSIs) in the treatment of lateral epicondylitis (LE). TYPE Meta-analysis. LITERATURE SURVEY We systematically searched the EMBASE, PubMed, the Cochrane Library and Web of Science to identify randomized controlled trials (RCTs) comparing ABPs versus CSIs for the treatment of LE without language and publication date restriction through April 2015. METHODOLOGY Two investigators independently included and assessed the quality of each eligible study according to the method recommended by the Cochrane Collaboration. Available data about the main outcomes were extracted from each study and heterogeneity was assessed using the Q statistic and the inconsistency index (I2). We also evaluated the publication bias and conducted a subgroup analysis. The Review Manager 5.2 software was used for data syntheses and analyses, the standardized mean difference (SMD) or mean difference (MD) were estimated by using random effects models with 95% confidence interval (CI). To investigate the efficacy among different trial durations, the follow-up times were therefore divided into short (2-4 weeks), intermediate (6-24 weeks) and long term (≥ 24 weeks). SYNTHESIS Ten RCTs (n = 509) were included in this meta-analysis. The pooled analysis showed that CSIs were more effective than ABPs on pain relief (SMD = 0.88; 95% CI = 0.31to1.46%; P = .003) in the short term. However, in the intermediate term, ABPs exhibited a better therapeutic effect for pain relief (SMD = -0.38; 95% CI = -0.70 to -0.07%; P = .02), function (SMD = -0.60; 95% CI = -1.13 to -0.08%; P = .03), DASH (MD = -11.04; 95% CI = -21.72 to -0.36%; P = .04), and Nirschl stage (MD = -0.81; 95% CI = -1.11 to -0.51%; P < .0001). In the long term, ABPs were superior to CSIs for pain relief (SMD = -0.94; 95% CI = -1.32 to -0.57%; P < .0001) and Nirschl stage (MD = -1.04; 95% CI = -1.66 to -0.42%; P = .001). Moreover, for grip strength recovery, there was no significant difference between the two therapies (p > .05). CONCLUSIONS There was limited evidence supporting the conclusion that CSIs were superior to ABPs for pain relief in the short term; however, this result was reversed in the intermediate and long term. ABPs seemed to be more effective at restoring function in the intermediate term. Due to the small sample size and the limited number of high-quality RCTs, more high-quality RCTs with large sample sizes are required to further validate this result.