Platelet-rich Plasma Has Better Mid-term Clinical Results than Traditional Steroid injection for Plantar Fasciitis: A systematic review and meta-analysis

Background: Platelet-rich plasma (PRP), as a promising alternative to traditional corticosteroid (CS), is now increasingly used in the treatment of elbow epicondylitis (EE) and plantar fasciitis (PF). To date, however, the synthesis of information on the clinical efficacy of PRP versus CS is limited with divergent conclusions. Purpose: To compare the clinical efficacy of PRP and CS injections in reducing pain and improving function in EE and PF. Study Design: Systematic review and meta-analysis. Methods: Online databases were searched from inception to October 2018 for prospective studies evaluating PRP versus CS injections for EE or PF. Independent reviewers undertook searches, screening, and risk-of-bias appraisals. The primary outcomes of interest were pain and function in both the short term (1-3 months) and the long term (≥6 months). Results: Twenty trials with 1268 participants were included. For EE, PRP provides a statistically and clinically meaningful long-term improvement in pain, with a very large effect size of −1.3 (95% CI, −1.9 to −0.7) when compared with CS, but the evidence level was low. For EE, there was moderate evidence that CS provides a statistically meaningful improvement in pain in the short term, with a medium effect size of 0.56 (95% CI, 0.08-1.03) as compared with PRP; this improvement might not be clinically significant. For PF, there was low evidence that PRP provides a statistically and clinically meaningful long-term improvement in function (American Orthopedic Foot & Ankle Society score), with a very large effect size of 1.94 (95% CI, 0.61-3.28). There were no significant differences between the groups in improvement in function in EE and pain and short-term function in PF, but the quality of the evidence was low. Conclusion: The use of PRP yields statistically and clinically better improvement in long-term pain than does CS in the treatment of EE. The use of PRP yields statistically and clinically better long-term functional improvement than that of CS in the treatment of PF.

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Platelet-rich plasma versus autologous blood versus steroid injection in lateral epicondylitis: systematic review and network meta-analysis

Journal of Orthopaedics and Traumatology ◽

10.1007/s10195-015-0376-5 ◽

2015 ◽

Vol 17 (2) ◽

pp. 101-112 ◽

Cited By ~ 56

Author(s):

Alisara Arirachakaran ◽

Amnat Sukthuayat ◽

Thaworn Sisayanarane ◽

Sorawut Laoratanavoraphong ◽

Wichan Kanchanatawan ◽

...

Keyword(s):

Systematic Review ◽

Steroid Injection ◽

Platelet Rich Plasma ◽

Meta Analysis ◽

Autologous Blood ◽

Lateral Epicondylitis

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Platelet-Rich Plasma Versus Corticosteroids in the Treatment of Chronic Plantar Fasciitis: A Systematic Review and Meta-analysis of Prospective Comparative Studies

The Journal of Foot & Ankle Surgery ◽

10.1053/j.jfas.2019.10.003 ◽

2020 ◽

Vol 59 (3) ◽

pp. 546-552 ◽

Cited By ~ 1

Author(s):

Nedal Alkhatib ◽

Motasem Salameh ◽

Abdulaziz F. Ahmed ◽

Eslam Alkaramany ◽

Ghalib Ahmed ◽

...

Keyword(s):

Systematic Review ◽

Comparative Studies ◽

Plantar Fasciitis ◽

Platelet Rich Plasma ◽

Meta Analysis

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Platelet-Rich Plasma Versus Corticosteroids for the Treatment of Plantar Fasciitis: A Systematic Review and Meta-analysis

The American Journal of Sports Medicine ◽

10.1177/0363546520937293 ◽

2020 ◽

pp. 036354652093729

Author(s):

Erik Hohmann ◽

Kevin Tetsworth ◽

Vaida Glatt

Keyword(s):

Systematic Review ◽

High Risk ◽

Plantar Fasciitis ◽

Platelet Rich Plasma ◽

Meta Analysis ◽

Risk Of Bias ◽

Foot And Ankle ◽

Analog Scale ◽

American Orthopaedic ◽

Corticosteroid Injections

Background: Plantar fasciitis is a common cause of heel pain. Corticosteroid injections are commonly used and proven to be effective, and lately platelet-rich plasma (PRP) has been used with mixed results. Purpose: To perform a systematic review and meta-analysis comparing intralesional injections of PRP and steroid infiltration. Study Design: Systematic review and meta-analysis. Methods: A systematic review of Medline, Embase, Scopus, and Google Scholar including all level 1 and 2 studies from 2010 to 2019 was perfomed. American Orthopaedic Foot and Ankle Society and visual analog scale for pain scores were used as outcome variables. Publication bias and risk of bias was assessed with the Cochrane Collaboration tools. The Grading of Recommendations, Assessment, Development and Evaluations system was used to assess the quality of the body of evidence. Heterogeneity was assessed with χ2 and I2 statistics. Results: Fifteen studies were included in the analysis. Nine studies had a high risk of bias. There was 1 study with high quality, 9 with moderate, 2 studies with low, and 3 with very low quality. The pooled estimate for the American Orthopaedic Foot and Ankle Society score demonstrated nonsignificant differences at 1 month ( P = .4) and 3 months ( P = .076). At 6 months ( P = .009) and 12 months ( P = .009), it indicated significant differences in favor of PRP. The pooled estimate for visual analog scale demonstrated nonsignificant differences at 1 month ( P = .653). At 3 months ( P = .0001), 6 months ( P = .002), and 12 months ( P = .019), it yielded significant differences in favor of PRP. Conclusion: The results of this systematic review and meta-analysis suggest that PRP is superior to corticosteroid injections for pain control at 3 months and lasts up to 1 year. In the short term, there is no advantage of corticosteroid infiltration. However, the low study quality, high risk of bias, and different protocols for PRP preparation reduce the internal and external validity of these findings, and these results must be viewed with caution.

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