Effectiveness of Platelet-Rich Plasma for Lateral Epicondylitis: A Systematic Review and Meta-analysis Based on Achievement of Minimal Clinically Important Difference

Abstract

Background: The effectiveness of platelet-rich plasma (PRP) injection in the treatment of lateral epicondylitis remains debatable. Purpose: To evaluate the effectiveness of PRP in lateral epicondylitis treatment using minimal clinically important difference (MCID) values as a reference and to investigate if leukocyte content can influence the effectiveness of the therapy. Study Design: Systematic review; Level of evidence, 4. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, the authors searched the Medline and Scopus databases for studies on lateral epicondylitis and PRP therapy that used the following patient-reported outcome measures (PROMs): visual analog scale (VAS) for pain; Disabilities of the Arm, Shoulder and Hand (DASH); Patient-Rated Tennis Elbow Evaluation (PRTEE); and Mayo Clinic Performance Index (MAYO). The weighted arithmetic means for the PROMs were calculated at baseline (week 0) and follow-up weeks 4, 8, 12, 24, 52, and 104. The mean differences in outcomes (ΔVAS, ΔDASH, ΔPRTEE, and ΔMAYO) were compared with the MCID values at each follow-up point. In addition, the effectiveness of leukocyte-rich PRP (LR-PRP) versus leukocyte-poor PRP (LP-PRP) was also compared. The Student t test was used in all analyses. Results: A total of 26 studies were included in the analysis. After PRP injection, all PROM scores improved with time. The scores improved significantly from baseline to each follow-up time ( P < .0001), with the exception of the PRTEE (no significant difference at follow-up weeks 12 and 52). The mean difference in scores from baseline exceeded the respective MCIDs from weeks 4 to 104 for the VAS and DASH, from weeks 4 to 52 for the MAYO, and from weeks 8 to 52 for the PRTEE. The MCID for each of the PROMs was exceeded at almost every observation period in both the LR-PRP and the LP-PRP systems. Conclusion: Based on comparisons with the MCID values of commonly used outcome scores, PRP seems to be an effective form of treatment for lateral epicondylitis. Both the LR- PRP and the LP- PRP systems were effective in the context of meeting the MCID.

Effectiveness of Lateral Elbow Tendinopathy Treatment Depends on the Content of Biologically Active Compounds in Autologous Platelet-Rich Plasma

“…Niemiec et al, in their meta-analysis of 26 studies with PRP injection for lateral epicondylopathy, established the treatment as effective in the achievement of MCID during all points of follow-up (4-104 weeks) [16]. In another meta-analysis based on 16 studies, Chen et al, found that despite a significant clinical improvement, they were unable to recommend for or against the use of PRP for lateral epicondylitis.…”

“…The treatment was considered effective if a minimal clinically important difference (MCID) occurred in pain reduction, or a functional improvement between the baseline and follow-up periods. According to the literature, a MCID is equal to 1.5 points for the VAS, 15.8 points for the DASH, and 11 points for the PRTEE [16].…”

“…There are many doubts about the efficacy of PRP injection in lateral elbow tendinopathy. Most publications have presented significant improvements, being better than corticosteroid injection at more than three months after treatment or even being equal to surgery [13][14][15][16]. On the other hand, some studies have reported similarly good outcomes after saline or autologous blood injection [14,17] while three months appeared to be the cut-off point for positive PRP treatment results.…”

“…Additional potential benefits of the use of a leukocyte-rich PRP include its antimicrobial properties and the ability to influence an immune response. The existing concerns about the negative impact on tissue healing due to an ability to stimulate catabolic reactions, and the release of pro-inflammatory cytokines and proteinases have not been confirmed in in vivo studies [15,16].…”

What Role Does PDGFA Gene Polymorphisms Play in Treating Tennis Elbow with PRP? A Prospective Cohort Study

“…Despite many years of research, the gold standard of treatment has not been established. More and more reports prove the usefulness of autologous platelet-rich plasma (PRP) in the treatment of TE [ 2 , 3 , 4 , 5 ]. This therapy is used in many fields of medicine, including regenerative and sports medicine [ 6 ].…”