Systematic Review
The Effect of Platelet-Rich Plasma on Clinical Outcomes in Lateral Epicondylitis

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Purpose

To evaluate the evidence for application of platelet-rich plasma (PRP) in lateral epicondylitis.

Methods

We carried out a systematic review of the current evidence on the effects of PRP in lateral epicondylitis on clinical outcomes. We performed a comprehensive search of the PubMed, Medline, Cochrane, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Embase databases using various combinations of the commercial names of each PRP preparation and “lateral epicondylitis” (with its associated terms), looking specifically at human studies. Data validity was assessed and collected on clinical outcome.

Results

Nine studies met the inclusion criteria, of which 5 were randomized controlled trials. Two cohort studies showed that PRP improved clinical satisfaction scores. One case-control study showed that PRP yielded a significantly greater improvement in symptoms compared with bupivacaine. Two randomized controlled trials compared the effect of injections of PRP and blood. Only 1 of the studies noted a significant difference at the 6-week time point. Three randomized controlled trials compared corticosteroids with PRP. Two of the smaller trials, which had follow-up periods of 6 weeks and 3 months, showed no significant difference between treatment groups. The largest randomized controlled trial found that PRP had significant benefit compared with corticosteroids with regard to pain and Disabilities of the Arm, Shoulder and Hand scores at 1- and 2-year time points.

Conclusions

This review highlights the limited but evolving evidence for the use of PRP in lateral epicondylitis; however, further research is required to understand the concentration and preparation that facilitate the best clinical outcome. Characterizing the timing of the intervention would optimize the health economics behind the decision to treat for the patient and health care provider.

Level of Evidence

Level III, systematic review of Level I to III studies.

Section snippets

Methods

This systematic review was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement.

Results

Of the 164 initially eligible articles, only 9 met the inclusion criteria.

Discussion

The studies included in this review add strength to the case for the clinical benefit of PRP in lateral epicondylitis, but arguably, the value of this review is in highlighting questions that still need to be answered. Thus any conclusions should be made cautiously and should aim to be instructive in future study design so that more high-quality evidence can be used to inform clinical practice. It is important to note that none of the trials included a non-treatment cohort; thus it cannot be

Conclusions

The current evidence suggests that PRP may be of benefit over standard treatment as a second-line intervention, but the question remains as to whether this can be justified in the face of financial austerity. The current evidence is promising but limited, and therefore further high-quality research must be undertaken to better characterize the optimal preparation of PRP, the appropriate recipient, and the timing of the intervention to maximize any benefit it may have. This will enable a more

References (20)

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The authors report that they have no conflicts of interest in the authorship and publication of this article.

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