Treatment of Lateral Epicondylitis With Autologous Blood, Platelet-Rich Plasma, or Corticosteroid Injections: A Systematic Review of Overlapping Meta-analyses

Introduction: Lateral epicondylitis is a common musculoskeletal disorder of the upper limb. Corticosteroid injection has been widely used as a major mode of treatment. However, better understanding of the pathophysiology of the disease led to a major change in treating the disease, with new options including platelet-rich plasma (PRP) are currently used. Objectives/research aim: To systematically evaluate the effect of corticosteroid versus PRP injections for the treatment of LE. Hypothesis: PRP injections provide longer-term therapeutic effect and less rate of complications compared to corticosteroid injection. Level of evidence: Level 2 evidence (4 included studies are of level 1 evidence, 1 study of level 2 evidence). Design: Systematic Review (according to PRISMA guidelines). Methods: Eleven databases used to search for relevant primary studies comparing the effects of corticosteroid and PRP injections for the treatment of LE. Quality appraisal of studies performed using Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0, CASP Randomised Controlled Trial Checklist, and SIGN Methodology Checklist 2. Results: 732 papers were identified. Five randomised controlled trials (250 Patients) met the inclusion criteria. Clinical findings: Corticosteroid injections provided rapid symptomatic improvement with maximum effect at 6/8/8 weeks before symptoms recurrence, whereas PRP showed slower ongoing improvements up to 24/52/104 weeks(3 studies). Corticosteroid showed more rapid symptomatic improvement of symptoms compared to PRP up to the study end-point of 3 months(1 study). Comparable therapeutic effects of corticosteroid and PRP were observed at 6 weeks(1 study). Ultrasonographic Findings: (1) Doppler activity decreased more significantly in patients who received corticosteroid compared to PRP. (2) Reduced tendon thickness and more patients with cortical erosion noted in corticosteroid group whereas increased tendon thickness and less number of patients with common extensor tendon tears noted in PRP group. (3) Fewer patients reported Probe-induced tenderness and oedema in the common extensor tendon in both corticosteroid and PRP groups (2 studies). Conclusion: Corticosteroid injections provide rapid therapeutic effect in the short-term with recurrence of symptoms afterwards, compared to the relatively slower but longer-term effect of platelet-rich plasma.

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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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Current Trends for Treating Lateral Epicondylitis

Clinics in Shoulder and Elbow ◽

10.5397/cise.2019.22.4.227 ◽

2019 ◽

Vol 22 (4) ◽

pp. 227-234

Author(s):

Gyeong Min Kim ◽

Seung Jin Yoo ◽

Sungwook Choi ◽

Yong-Geun Park

Keyword(s):

Tennis Elbow ◽

Platelet Rich Plasma ◽

Autologous Blood ◽

Lateral Epicondylitis ◽

Blood Platelet ◽

Functional Improvement ◽

Therapeutic Trials ◽

Current Trends ◽

Interventional Therapies

Lateral epicondylitis, also known as ‘tennis elbow’, is a degenerative rather than inflammatory tendinopathy, causing chronic recalcitrant pain in elbow joints. Although most patients with lateral epicondylitis resolve spontaneously or with standard conservative management, few refractory lateral epicondylitis are candidates for alternative non-operative and operative modalities. Other than standard conservative treatments including rest, analgesics, non-steroidal anti-inflammatory medications, orthosis and physical therapies, nonoperative treatments encompass interventional therapies include different types of injections, such as corticosteroid, lidocaine, autologous blood, platelet-rich plasma, and botulinum toxin, which are available for both short-term and long-term outcomes in pain resolution and functional improvement. In addition, newly emerging biologic enhancement products such as bone marrow aspirate concentrate and autologous tenocyte injectates are also under clinical use and investigations. Despite all non-operative therapeutic trials, persistent debilitating pain in patients with lateral epicondylitis for more than 6 months are candidates for surgical treatment, which include open, percutaneous, and arthroscopic approaches. This review addresses the current updates on emerging non-operative injection therapies as well as arthroscopic intervention in lateral epicondylitis.

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Comparative Outcomes of Platelet Rich Plasma, Autologous Blood and Corticosteroid Injections in the Treatment of Lateral Epicondylitis

Hand and Microsurgery ◽

10.5455/handmicrosurg.64347 ◽

2020 ◽

pp. 1

Author(s):

huseyin Karahan ◽

RECEP EYCEYURT ◽

Levent Kucuk ◽

Huseyin Gunay ◽

Erhan Coskunol

Keyword(s):

Platelet Rich Plasma ◽

Autologous Blood ◽

Lateral Epicondylitis ◽

Corticosteroid Injections

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Systematic Review: Allogenic Use of Stromal Vascular Fraction (SVF) and Decellularized Extracellular Matrices (ECM) as Advanced Therapy Medicinal Products (ATMP) in Tissue Regeneration

International Journal of Molecular Sciences ◽

10.3390/ijms21144982 ◽

2020 ◽

Vol 21 (14) ◽

pp. 4982 ◽

Cited By ~ 1

Author(s):

Pietro Gentile ◽

Aris Sterodimas ◽

Jacopo Pizzicannella ◽

Laura Dionisi ◽

Domenico De Fazio ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Stromal Vascular Fraction ◽

Lateral Epicondylitis ◽

Medicinal Products ◽

Advanced Therapy Medicinal Products ◽

Advanced Therapy ◽

Meta Analyses ◽

Clinical Experiments

Stromal vascular fraction (SVF) containing adipose stem cells (ASCs) has been used for many years in regenerative plastic surgery for autologous applications, without any focus on their potential allogenic role. Allogenic SVF transplants could be based on the possibility to use decellularized extracellular matrix (ECM) as a scaffold from a donor then re-cellularized by ASCs of the recipient, in order to develop the advanced therapy medicinal products (ATMP) in fully personalized clinical approaches. A systematic review of this field has been realized in accordance with the Preferred Reporting for Items for Systematic Reviews and Meta-Analyses-Protocols (PRISMA-P) guidelines. Multistep research of the PubMed, Embase, MEDLINE, Pre-MEDLINE, PsycINFO, CINAHL, Clinicaltrials.gov, Scopus database, and Cochrane databases has been conducted to identify articles and investigations on human allogenic ASCs transplant for clinical use. Of the 341 articles identified, 313 were initially assessed for eligibility on the basis of the abstract. Of these, only 29 met all the predetermined criteria for inclusion according to the PICOS (patients, intervention, comparator, outcomes, and study design) approach, and 19 have been included in quantitative synthesis (meta-analysis). Ninety-one percent of the studies previously screened (284 papers) were focused on the in vitro results and pre-clinical experiments. The allogenic use regarded the treatment of perianal fistulas, diabetic foot ulcers, knee osteoarthritis, acute respiratory distress syndrome, refractory rheumatoid arthritis, pediatrics disease, fecal incontinence, ischemic heart disease, autoimmune encephalomyelitis, lateral epicondylitis, and soft tissue defects. The information analyzed suggested the safety and efficacy of allogenic ASCs and ECM transplants without major side effects.

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Effect of Platelet-Rich Plasma (PRP) versus Autologous Whole Blood on Pain and Function Improvement in Tennis Elbow: A Randomized Clinical Trial

Pain Research and Treatment ◽

10.1155/2014/191525 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 8

Author(s):

Seyed Ahmad Raeissadat ◽

Leyla Sedighipour ◽

Seyed Mansoor Rayegani ◽

Mohammad Hasan Bahrami ◽

Masume Bayat ◽

...

Keyword(s):

Whole Blood ◽

Tennis Elbow ◽

Platelet Rich Plasma ◽

Autologous Blood ◽

Pressure Pain Threshold ◽

Lateral Epicondylitis ◽

Autologous Whole Blood ◽

Significant Difference ◽

Group 2 ◽

And Function

Background. Autologous whole blood and platelet-rich plasma (PRP) have been both suggested to treat chronic tennis elbow. The aim of the present study was to compare the effects of PRP versus autologous whole blood local injection in chronic tennis elbow. Methods. Forty patients with tennis elbow were randomly divided into 2 groups. Group 1 was treated with a single injection of 2 mL of autologous PRP and group 2 with 2 mL of autologous blood. Tennis elbow strap, stretching, and strengthening exercises were administered for both groups during a 2-month followup. Pain and functional improvements were assessed using visual analog scale (VAS), modified Mayo Clinic performance index for the elbow, and pressure pain threshold (PPT) at 0, 4, and 8 weeks. Results. All pain and functional variables including VAS, PPT, and Mayo scores improved significantly in both groups 4 weeks after injection. No statistically significant difference was noted between groups regarding pain scores in 4-week follow-up examination (P>0.05). At 8-week reevaluations, VAS and Mayo scores improved only in PRP group (P<0.05). Conclusion. PRP and autologous whole blood injections are both effective to treat chronic lateral epicondylitis. PRP might be slightly superior in 8-week followup. However, further studies are suggested to get definite conclusion.

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Autologous Blood and Platelet-Rich Plasma Injections for Treatment of Lateral Epicondylitis

Orthopedic Clinics of North America ◽

10.1016/j.ocl.2017.03.011 ◽

2017 ◽

Vol 48 (3) ◽

pp. 351-357 ◽

Cited By ~ 7

Author(s):

James H. Calandruccio ◽

Murphy M. Steiner

Keyword(s):

Platelet Rich Plasma ◽

Autologous Blood ◽

Lateral Epicondylitis

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Systematic Review of Platelet-Rich Plasma Use in Androgenetic Alopecia Compared with Minoxidil®, Finasteride®, and Adult Stem Cell-Based Therapy

International Journal of Molecular Sciences ◽

10.3390/ijms21082702 ◽

2020 ◽

Vol 21 (8) ◽

pp. 2702 ◽

Cited By ~ 12

Author(s):

Pietro Gentile ◽

Simone Garcovich

Keyword(s):

Systematic Review ◽

Hair Loss ◽

Platelet Rich Plasma ◽

Adult Stem Cell ◽

Lower Grade ◽

Androgenic Alopecia ◽

Positive Effects ◽

Cell Based Therapy ◽

Local Injections ◽

Meta Analyses

The number of articles evaluating platelet-rich plasma (PRP) efficacy in androgenic alopecia (AGA) have exponentially increased during the last decade. A systematic review on this field was performed by assessing in the selected studies the local injections of PRP compared to any control for AGA. The protocol was developed in accordance with the Preferred Reporting for Items for Systematic Reviews and Meta-Analyses-Protocols (PRISMA-P) guidelines. A multistep search of the PubMed, MEDLINE, Embase, PreMEDLINE, Ebase, CINAHL, PsycINFO, Clinicaltrials.gov, Scopus database, and Cochrane databases was performed to identify studies on hair loss treatment with platelet-rich plasma. Of the 163 articles initially identified, 123 articles focusing on AGA were selected and, consequently, only 12 clinical trials were analyzed. The studies included had to match predetermined criteria according to the PICOS (patients, intervention, comparator, outcomes, and study design) approach. In total, 84% of the studies reported a positive effect of PRP for AGA treatment. Among them, 50% of the studies demonstrated a statistically significant improvement using objective measures and 34% of the studies showed hair density and hair thickness improvement, although no p values or statistical analysis was described. In total, 17% of the studies reported greater improvement in lower-grade AGA, while 8% noted increased improvement in higher-grade AGA. Only 17% of the studies reported that PRP was not effective in treating AGA. The information analyzed highlights the positive effects of PRP on AGA, without major side effects and thus it be may considered as a safe and effective alternative procedure to treat hair loss compared with Minoxidil® and Finasteride®.

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The effects of regenerative injection therapy compared to corticosteroids for the treatment of lateral Epicondylitis: a systematic review and meta-analysis

Archives of Physiotherapy ◽

10.1186/s40945-019-0063-6 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 3

Author(s):

Julie Barnett ◽

Madison N. Bernacki ◽

Jessica L. Kainer ◽

Hannah N. Smith ◽

Annette M. Zaharoff ◽

...

Keyword(s):

English Language ◽

Platelet Rich Plasma ◽

Meta Analysis ◽

Functional Limitations ◽

Autologous Blood ◽

Lateral Epicondylitis ◽

Risk Of Bias ◽

Injection Therapy ◽

Lateral Epicondyle

Abstract Background The lateral epicondyle is a common site for chronic tendinosis (i.e. lateral epicondylitis), a condition characterized by overuse and degeneration of a tendon due to repeated microtrauma. This leads to pain and functional limitations. There is a growing interest in non-surgical forms of treatment for this condition including provision of corticosteroid injections and regenerative injection therapy (provision of autologous blood and platelet rich plasma injections). Objective We compared the effectiveness of corticosteroids with regenerative injection therapy for the treatment of lateral epicondylitis. Methods We systematically reviewed randomized controlled trials published in English language from 2008 to 2018. Databases used included PEDro, Scopus, PubMed, and CINAHL. Nine articles met our selection criteria. The PEDRo scale scores helped assess study quality. Cochrane risk of bias criteria helped assess bias. We analyzed results focusing on pain and function using meta-analyses. Results Six out of 9 studies had low risk of bias. There were no short-term (1 and 2 month) differences in pain scores between the corticosteroid and regenerative injection groups. Participants receiving regenerative injections demonstrated greater long-term improvements lasting for a period of ≈2 years. Conclusion Regenerative injections provision results in greater long–term pain relief and improved function for people with lateral epicondylitis.

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