PMID- 33964386 OWN - NLM STAT- MEDLINE DCOM- 20210917 LR - 20220421 IS - 1526-3231 (Electronic) IS - 0749-8063 (Linking) VI - 37 IP - 9 DP - 2021 Sep TI - The Efficacy of Platelet-Rich Plasma for Improving Pain and Function in Lateral Epicondylitis: A Systematic Review and Meta-analysis with Risk-of-Bias Assessment. PG - 2937-2952 LID - S0749-8063(21)00453-9 [pii] LID - 10.1016/j.arthro.2021.04.061 [doi] AB - PURPOSE: To assess the efficacy of platelet-rich plasma (PRP) for lateral epicondylitis and evaluate its impact on pain and functional outcomes. METHODS: This study followed Preferred Reporting Items and Systematic Reviews and Meta-Analyses guidelines. A comprehensive literature search was conducted in September 2019 and repeated in April 2020 using electronic databases PubMed, MEDLINE, and the Cochrane Library. Baseline and 3-, 6-, and 12-month data were extracted for visual analog scale (VAS), Disabilities of the Arm, Shoulder, and Hand (DASH), and modified Mayo Clinic performance index for the elbow (MAYO) scores. Only level 1 studies with patients who had not undergone surgery were included. Outcomes data, study design, demographic variables, PRP formulation, and comparator treatments were recorded. Statistical analyses of pooled weighted mean differences (WMDs) were performed and compared with estimated minimal clinically important difference (MCID) values. The Coleman Methodology Score (CMS) was used to assess methodological quality, and the Cochrane risk-of-bias assessment was performed. RESULTS: This review included 16 level I studies, 9 of which (581 total patients, 281 receiving single injections of PRP) were quantitatively analyzed. The average age was 41.5 years, 56.8% of patients were female, and mean follow-up was 7.5 months. The mean CMS was 78.94 +/- 12.74 (range 59 to 97), and 5 of 16 studies were at low risk for bias. Patients who received PRP had significantly improved VAS scores at 3 months (WMD -0.85; 95% confidence interval [CI] -1.03, -0.66; P < .01) and 6 months (WMD -0.74; 95% CI -0.98, -0.50; P < .01) compared with those who received autologous whole blood, though MAYO scores were statistically equivalent. Comparing PRP to corticosteroids, VAS and DASH scores were not significantly different at 3 months, although PRP was superior at 6 months for VAS (WMD -1.70; 95% CI -2.65, -0.75; P < .01) and DASH (WMD -6.23; 95% CI -10.78, -1.69; P < .01). Most differences in VAS and DASH scores exceeded the 5% absolute difference estimate for their respective MCIDs but fell short of the 10% estimate. CONCLUSION: Considering the small number of comparable studies, lack of quantification of specific PRP content, considerable heterogeneity between randomized control trials, and most effect sizes being equivocal within the framework of 2 estimated MCID values, the authors can neither scientifically support nor discourage the usage of PRP for lateral epicondylitis despite finding statistically significant improvements in pain and functional outcomes. LEVEL OF EVIDENCE: I, prognostic. CI - Copyright (c) 2021. Published by Elsevier Inc. FAU - Chen, Xiao T AU - Chen XT AD - Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California, U.S.A. FAU - Fang, William AU - Fang W AD - Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California, U.S.A. FAU - Jones, Ian A AU - Jones IA AD - University of California, Irvine, School of Medicine, Irvine, California, U.S.A. FAU - Heckmann, Nathanael D AU - Heckmann ND AD - Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California, U.S.A. FAU - Park, Caron AU - Park C AD - Southern California Clinical and Translational Science Institute, Los Angeles, California, U.S.A. FAU - Vangsness, C Thomas Jr AU - Vangsness CT Jr AD - Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California, U.S.A.. Electronic address: vangsness@usc.edu. LA - eng PT - Journal Article PT - Meta-Analysis PT - Systematic Review DEP - 20210505 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 SB - IM MH - Adult MH - Female MH - Humans MH - Pain MH - Pain Measurement MH - *Platelet-Rich Plasma MH - *Tennis Elbow/therapy MH - Treatment Outcome MH - Visual Analog Scale EDAT- 2021/05/09 06:00 MHDA- 2021/09/18 06:00 CRDT- 2021/05/08 20:11 PHST- 2020/10/21 00:00 [received] PHST- 2021/04/14 00:00 [revised] PHST- 2021/04/23 00:00 [accepted] PHST- 2021/05/09 06:00 [pubmed] PHST- 2021/09/18 06:00 [medline] PHST- 2021/05/08 20:11 [entrez] AID - S0749-8063(21)00453-9 [pii] AID - 10.1016/j.arthro.2021.04.061 [doi] PST - ppublish SO - Arthroscopy. 2021 Sep;37(9):2937-2952. doi: 10.1016/j.arthro.2021.04.061. Epub 2021 May 5.