Platelet-rich plasma therapy ensures pain reduction in the management of lateral epicondylitis – a PRISMA-compliant network meta-analysis of randomized controlled trials
Sathish Muthu, Sandeep Patel, Ashwin Gobbur, Sandesh C Patil, Karthikav Hathwar Ks, Vijendra Yadav, Madhan Jeyaraman
Abstract
OBJECTIVES: Analyze the effectiveness of PRP therapy in comparison to other available treatments in the management of lateral epicondylitis (LE). MATERIALS AND METHODS: We conducted electronic database searches in PubMed, Embase, Web of Science, and Cochrane Library until June 2021 for RCTs analyzing the efficacy of PRP in the management of LE. VAS for pain, DASH score, and PRETEE score were the outcomes analyzed. The analysis was performed in R-platform using MetaInsight and interventions were ranked based on p-score approach. Cochrane's CINeMA approach was used for quality appraisal. RESULTS: Twenty-five RCTs with 2040 patients were included in the network analysis. Compared to saline control, only leukocyte-rich-PRP resulted in significant pain relief (WMD=-14.8,95% CI [-23.18,-6.39];low confidence) compared to steroid, local anesthetic, laser, and surgery. On analyzing DASH scores and PRETEE scores, none of the above-mentioned treatment methods were superior to saline control. In subgroup analysis, leucocyte-rich-PRP resulted in clinically significant improvement. Leucocyte-rich-PRP seems more promising with p-score of 0.415. CONCLUSION: PRP therapy offers significant pain relief compared to saline control in the management of LE without similar improvement in functional outcome. With available low-quality evidence, PRP was the most promising therapy that needs further exploration to explore its usefulness in lateral epicondylitis.