Effectiveness of platelet-rich plasma in treatment of lateral epicondylitis – a systematic review and meta-analysis
Platelet-rich plasma (PRP) is prepared from centrifuging whole blood extracted from the patient, resulting in platelet concentration that is higher than that of whole blood. It is assumed that PRP enhances the tissue healing. PRP has widely been used in the treatment of lateral epicondylitis even though the evidence of its effectiveness has been unclear.
To investigate the evidence on effectiveness of PRP in lateral epicondylitis.
Cochrane Controlled Trials Register (CENTRAL), Medline, Embase, Cinahl, Web of Science and Scopus databases. The effect sizes were calculated as a standardized difference in means between groups along with Cohen's U3, Percent of overlap, Probability of superiority, and Number Needed to Treat.
Of the 1,154 records identified via database search, 18 were considered relevant for the qualitative analysis and 12 records for the quantitative analysis. PRP versus anesthetic or saline injection: when combining all the outcomes and all the time points, the pooled effect size of five samples was -0.6 with heterogeneity of 78% and NNT of 6.2. Respective figure for <3 months effect was -0.6 and the effect sizes for follow-ups over 3 months were insignificant. PRP versus cortisone injection: the pooled effect size of six samples was -1.1 with heterogeneity of 87% and moderate NNT of 3.2. PRP versus autologous whole blood: All the pooled effect sizes for all periods of follow-up were insignificant with heterogeneity 96%. PRP versus arthroscopy: when combining all the outcomes and all the time points, the pooled effect size of a single sample was -0.6 with high NNT of 6.4.
No strong evidence was found on the effectiveness of PRP in treatment of lateral epicondylitis when PRP was compared with local anesthetic or saline, corticosteroid injections, arthroscopic tendon release, or other treatment. Even though some effects of PRP were statistically significant, high NNT figures do not support the use of PRP over other treatments of lateral epicondylitis.
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