Meta-Analysis Shows PRP Improves Tennis Elbow

Tennis Elbow

Lateral epicondylitis, more commonly known as tennis elbow, is the most frequent reason people see the physician for elbow pain. Tennis elbow is a swelling of the tendons that connect the lower arm to the elbow and is caused by any repetitive, gripping type activities – not just tennis. Corticosteroid (CS) injections offer short-term relief and have been the treatment of choice since the 1950s, but since several studies have shown no long-term benefit from steroid injections clinicians are turning to newer biological therapies. Orthopedic researchers in Bangkok, Thailand conducted a systematic review and meta-analysis to compare the clinical effects of two biological treatment options, autologous blood(AB) and platelet-rich plasma (PRP), to corticosteroid injections.

The Study Method

• Computer searches were used to identify randomized controlled trials or quasi-experimental designs that compared clinical outcomes between PRP, autologous blood and corticosteroid treatments in patients with tennis elbow.
• The outcomes of interest were a pain, disability, and function as measured by validated and standardized assessment questionnaires. Of 374 identified studies, 10 met the study criteria and were included in the meta-analysis. Meta-analysis is a method of pooling data from similarly designed studies to determine effects which might not be evident in individual studies. Most studies reported outcomes for more than 2 months.

PRP Tennis Elbow Results

• Autologous blood showed significantly improved pain, function, and disability scores when compared to corticosteroid injections.
• PRP showed significantly improved pain and disability scores when compared to corticosteroid and lower pain scores when compared to autologous blood.
• Autologous blood showed a higher risk of adverse effects when compared to corticosteroid and PRP.
• Conclusions indicate that PRP can improve pain and lower the risk of complications.

Why Are These Findings Significant?

Many studies in the literature have design flaws (such as small sample size) that limit the ability to make conclusions. It is often difficult to conduct studies at one location because there may not be enough available subjects to reach statistical significance.

• This study identified previous studies that met strict inclusion criteria and had similar quality design methods. By pooling data from these other studies, the current study was able to increase the size of the subject pool.
• Increased subject size allows for assessment effects that would not otherwise be available. This methodology allowed for the conclusion that although both PRP and autologous blood improve pain and disability scores, PRP is superior since it does not cause the side effects seen with AB.

Arirachakaran, A.,   Sukthuayat, A., Sisayanarane, T., Laoratanavoraphong, S., Kanchanatawan, W. & Kongtharvonskul, J. (2016). Platelet-rich plasma versus autologous blood versus steroid injection in lateral epicondylitis: a systematic review and network meta-analysis. J of Orthop Traumatology, 17(2): 101-112

doi:  10.1007/s10195-015-0376-5

Tennis elbow

Tennis Elbow