Management of Lateral Epicondylitis (Tennis elbow). A study published in July 2019.

The Study

Xu et al (Int J Surg. 2019 Jul;67:37-46S) analysed seven Randomised controlled trials of 515 patients who were included in this meta-analysis comparing local injection of platelet concentrate and local injection of corticosteroid for the treatment of lateral epicondylitis. Outcomes of interest included pain on a Visual Analog Scale (VAS), the Modified Mayo Performance Index, the Disability of the Arm, Shoulder and Hand (DASH) score, and the risk of adverse events. Outcomes were analyzed up to 6 months post-treatment. Results revealed significantly favourable VAS pain, Mayo, and DASH scores in the platelets group compared to the corticosteroid group at all time points. The risk of adverse events was not significantly different between the two groups.

What were the important findings?

  • Pooled Visual Analog Scale (VAS) scores were significantly in favour of the platelet group compared to the corticosteroid group at 1 month (6 studies; WMD=-0.253 [95% CI -0.403, -0.103], p=0.001; GRADE=low), 2 months (5 studies; WMD=-0.205 [95% CI -0.344, -0.067], p=0.004; GRADE=low) and 6 months (4 studies; WMD=-0.391 [95%CI -0.428, -0.35], p<0.001; GRADE=moderate) post-treatment.

  • Pooled Mayo scores were significantly in favour of the platelet group compared to the corticosteroid group at 1 month (4 studies; WMD=5.286 [95% CI 3.877, 6.694], p<0.001; GRADE=moderate), 2 months (3 studies; WMD=1.665 [95%CI 0.367, 2.962], p=0.012; GRADE=moderate), and 6 months (3 studies; WMD=1.666 [95% CI 1.183, 2.149], p<0.001; GRADE=moderate) post-treatment.

  • Pooled DASH scores were significantly in favour of the platelet group compared to the corticosteroid group at both 1 month (3 studies; WMD=-4.36 [95% CI -8.56, -0.16]; GRADE=moderate) and 6 months (3 studies; WMD=-5.64 [95% CI -10.40, -0.88]; GRADE=moderate) post-treatment.

  • The pooled adverse event rate revealed no significant difference between locally injected PRP and corticosteroid in the risk of adverse events (3 studies; RD=-0.012 [95% CI -0.059, 0.035], p=0.612)

Take Home Message

Pooled results from the meta-analysis revealed significantly favourable VAS pain scores, Mayo scores, and DASH scores with local platelet injection compared to local corticosteroid injections, up to 6 months post-treatment. No significant differences in the risk of adverse events were observed between the platelet and corticosteroid injections.

Conclusions

Findings from this study suggest that local injection with platelets provide favourable pain relief and functional improvement, with no increase in adverse events, compared to local injection of corticosteroid for the treatment of lateral epicondylitis. Future studies are needed to affirm the results of this meta-analysis, as well as investigate treatment effects beyond 6 months post-treatment.

M-Imam

By Professor Mohamed Imam

Orthopaedic Surgery in London

Professor Mohamed Imam is an exceptionally skilled consultant orthopaedic surgeon who specialises in upper limb surgery, sports injuries, and complex trauma. Professor Imam uses the latest technology in diagnosing a wide

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