2019 ISAKOS Biennial Congress ePoster #502
Treatment of Lateral Epicondylitis with Autologous Blood, Platelet-Rich Plasma, or Corticosteroid Injections: A Systematic Review of Overlapping Meta-Analyses
Ilona Schwarz, MS, Boulder, CO UNITED STATES
Matthew J. Kraeutler, MD, Houston, TX UNITED STATES
Loree B. Thornton, BA, Aurora, CO UNITED STATES
Eric C. McCarty, MD, Boulder, CO UNITED STATES
Jonathan T. Bravman, MD, Denver, CO UNITED STATES
University of Colorado, Dept. of Orthopaedics, Aurora, CO, UNITED STATES
FDA Status Not Applicable
Summary
The current best available evidence suggests CSI improves functional outcomes and pain relief in the short-term, while AB and PRP are the most effective treatments in the intermediate-term.
Abstract
Purpose
The purpose of this study was to conduct a systematic review of overlapping meta-analyses comparing different injection treatments for lateral epicondylitis (LE) including corticosteroid injections (CSI), and autologous blood products (ABP), such as autologous blood (AB), and platelet-rich plasma (PRP) to determine which meta-analyses provide the best available evidence.
Methods
A systematic review was performed by searching PubMed, Embase and Cochrane Library to locate meta-analyses which compared clinical outcomes of CSI, AB, and PRP for the treatment of LE. Search terms included “injection”, “corticosteroid”, “platelet-rich plasma”, “autologous blood”, “tennis elbow”, “lateral epicondylitis”, and “meta-analysis”. Studies were reviewed for eligibility. Outcomes were extracted from these meta-analyses. Meta-analysis quality was assessed using the Oxman-Guyatt and Quality of Reporting Meta-analyses (QUOROM) systems. The Jadad decision algorithm was used to determine which meta-analyses provided the best level of evidence (LOE).
Results
Nine meta-analyses containing 8,656 patients met the eligibility criteria. Seven meta-analyses found that ABP significantly improve pain and elbow function in the intermediate-term (12-26 weeks). Four studies demonstrated CSI would effectively relieve pain and improve function in the short-term (<12 weeks). Arirachakarn et al received the highest QUOROM and Oxman-Guyatt scores. Therefore, appears to have the highest LOE. According to the Jadad model, this study was rated as the highest quality study in this systematic review. Lower quality meta-analyses indicate that dosage, injection number, and follow-up period may be essential factors in determining the appropriate LE treatment injection protocol.
Conclusions
The current best available evidence suggests CSI improves functional outcomes and pain relief in the short-term, while AB and PRP are the most effective treatments in the intermediate-term.