PMID- 31072722
OWN - NLM
STAT- MEDLINE
DCOM- 20200330
LR  - 20200330
IS  - 1526-3231 (Electronic)
IS  - 0749-8063 (Linking)
VI  - 35
IP  - 6
DP  - 2019 Jun
TI  - The Therapeutic Benefits of Saline Solution Injection for Lateral Epicondylitis: 
      A Meta-analysis of Randomized Controlled Trials Comparing Saline Injections With 
      Nonsurgical Injection Therapies.
PG  - 1847-1859.e12
LID - S0749-8063(19)30220-8 [pii]
LID - 10.1016/j.arthro.2019.02.051 [doi]
AB  - PURPOSE: To quantify the effect of saline solution injections on patient-reported 
      outcome measures (PROMs) and to determine whether this effect is clinically 
      relevant by comparing it with minimal clinically important difference (MCID) 
      criteria. METHODS: A systematic search identified randomized controlled trials of 
      lateral epicondylitis interventions comparing saline solution injections with 
      nonsurgical injection therapies. Among included studies, saline solution was 
      compared with platelet-rich plasma, autologous conditioned plasma, 
      corticosteroid, and botulinum toxin injections. By use of data from included 
      studies, a random-effects model was used to calculate overall mean differences 
      (MDs) in pre- and post-injection PROMs in a pair-wise fashion. Calculated MDs 
      were then compared with MCID criteria. RESULTS: Of 458 identified studies, 10 met 
      the inclusion criteria and encompassed 283 patients. At 1, 3, 6, and 12 months, 
      statistically significant improvements in MDs in visual analog scale (VAS) scores 
      were noted as follows: MD of 16.11 (95% confidence interval [CI], 8.29-23.93) at 
      1 month; MD of 22.50 (95% CI, 11.45-33.55) at 3 months; MD of 40.40 (95% CI, 
      27.48-53.32) at 6 months; and MD of 47.04 (95% CI, 39.43-54.66) at 12 months. At 
      6 months, Disabilities of the Arm, Shoulder and Hand scores showed a 
      statistically significant improvement (MD, 23.92; 95% CI, 9.47-38.37). 
      CONCLUSIONS: Improvements in Disabilities of the Arm, Shoulder and Hand scores at 
      6 months (23.92) surpassed MCID criteria for conservatively managed 
      upper-extremity musculoskeletal pathology (10.83)-suggesting that saline solution 
      injections have a clinically relevant effect. VAS MCID criteria are poorly 
      established, but VAS scores at 6 and 12 months surpassed MCID criteria for 
      conservative treatments for common orthopaedic conditions. In all but 1 study, no 
      statistically significant difference in PROMs was found between saline solution 
      and non-saline solution injections. LEVEL OF EVIDENCE: Level II, meta-analysis of 
      Level I and II randomized controlled trials.
CI  - Copyright (c) 2019 Arthroscopy Association of North America. Published by Elsevier 
      Inc. All rights reserved.
FAU - Gao, Burke
AU  - Gao B
AD  - The Warren Alpert Medical School of Brown University, Providence, Rhode Island, 
      U.S.A.. Electronic address: burkegao@gmail.com.
FAU - Dwivedi, Shashank
AU  - Dwivedi S
AD  - Department of Orthopaedic Surgery, The Warren Alpert Medical School of Brown 
      University, Providence, Rhode Island, U.S.A.
FAU - DeFroda, Steven
AU  - DeFroda S
AD  - Department of Orthopaedic Surgery, The Warren Alpert Medical School of Brown 
      University, Providence, Rhode Island, U.S.A.
FAU - Bokshan, Steven
AU  - Bokshan S
AD  - Department of Orthopaedic Surgery, The Warren Alpert Medical School of Brown 
      University, Providence, Rhode Island, U.S.A.
FAU - Ready, Lauren V
AU  - Ready LV
AD  - The Warren Alpert Medical School of Brown University, Providence, Rhode Island, 
      U.S.A.
FAU - Cole, Brian J
AU  - Cole BJ
AD  - Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, 
      Illinois, U.S.A.
FAU - Owens, Brett D
AU  - Owens BD
AD  - Department of Orthopaedic Surgery, The Warren Alpert Medical School of Brown 
      University, Providence, Rhode Island, U.S.A.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
DEP - 20190506
PL  - United States
TA  - Arthroscopy
JT  - Arthroscopy : the journal of arthroscopic & related surgery : official 
      publication of the Arthroscopy Association of North America and the International 
      Arthroscopy Association
JID - 8506498
RN  - 0 (Glucocorticoids)
RN  - 0 (Saline Solution)
SB  - IM
MH  - Glucocorticoids/administration & dosage/therapeutic use
MH  - Humans
MH  - Injections, Intra-Articular
MH  - Patient Reported Outcome Measures
MH  - Platelet-Rich Plasma
MH  - Randomized Controlled Trials as Topic/methods
MH  - Saline Solution/administration & dosage/*therapeutic use
MH  - Tennis Elbow/*therapy
MH  - Treatment Outcome
EDAT- 2019/05/11 06:00
MHDA- 2020/03/31 06:00
CRDT- 2019/05/11 06:00
PHST- 2018/08/14 00:00 [received]
PHST- 2019/01/26 00:00 [revised]
PHST- 2019/02/07 00:00 [accepted]
PHST- 2019/05/11 06:00 [pubmed]
PHST- 2020/03/31 06:00 [medline]
PHST- 2019/05/11 06:00 [entrez]
AID - S0749-8063(19)30220-8 [pii]
AID - 10.1016/j.arthro.2019.02.051 [doi]
PST - ppublish
SO  - Arthroscopy. 2019 Jun;35(6):1847-1859.e12. doi: 10.1016/j.arthro.2019.02.051. 
      Epub 2019 May 6.