Platelet-Rich Plasma (PRP) vs. Autologous Blood (AB) vs. Corticosteroid (CS) Injections for Tennis Elbow: Study Overview and Significance
Lateral Epicondylitis (Tennis Elbow) is a common cause of elbow pain, often resulting from repetitive gripping activities. The traditional treatment, corticosteroid injections, provides short-term relief but has been associated with minimal long-term benefits and increased risks of tendon injury and cartilage damage. In recent years, biological therapies, such as Platelet-Rich Plasma (PRP) and Autologous Blood (AB) injections, have emerged as alternatives. A systemic review and meta-analysis conducted by researchers in Bangkok compared the clinical effects of PRP, AB, and corticosteroids for tennis elbow.
Study Methodology
• Inclusion Criteria: The study reviewed randomized controlled trials or quasi-experimental designs that compared the clinical outcomes of PRP, AB, and corticosteroid treatments in patients with tennis elbow.
• Outcomes Measured: Pain, disability, and function were assessed using standardized questionnaires.
• Number of Studies: 374 studies were initially identified, of which 10 met the criteria and were included in the meta-analysis. Most studies reported outcomes for more than 2 months.
Results of the Meta-Analysis
1. Autologous Blood (AB):
• Showed significant improvements in pain, function, and disability scores when compared to corticosteroids.
2. Platelet-Rich Plasma (PRP):
• Showed significantly better outcomes in pain and disability scores compared to corticosteroids.
• Demonstrated lower pain scores than AB, suggesting that PRP may be more effective for pain relief.
Direct Comparison Analysis
• In 7 out of 10 studies, PRP showed significantly lower pain scores compared to AB (UMD = -1.1).
• Disability Scores: In 3 studies, PRP and AB showed significant improvement over corticosteroids.
• The patient-related tennis elbow evaluation score was significantly better for PRP compared to AB in 3 studies.
Network Meta-Analysis (Indirect Comparisons)
• At 2 months post-treatment, corticosteroid injections showed slightly lower pain scores, but these differences were not statistically significant. By last follow-up, both PRP and AB had significantly lower pain scores than corticosteroids.
• Disability scores showed significant improvement with AB at 2 months, but by the final follow-up, the differences between AB and PRP were no longer significant.
• Pressure-pain threshold was highest for AB at both 2 months and final follow-up. AB showed significant improvement compared to PRP and corticosteroids in this measure.
Risks and Adverse Effects
• Autologous Blood (AB) had a higher risk of adverse effects compared to both corticosteroids and PRP, including increased risk of complications.
• Platelet-Rich Plasma (PRP) showed fewer complications and improved outcomes, making it a safer and more effective alternative to corticosteroids and AB for treating tennis elbow.
Conclusions
• PRP has shown superior effectiveness for pain reduction and disability improvement compared to both AB and corticosteroids.
• PRP has a lower risk of side effects than AB and corticosteroids, making it a promising option for tennis elbow treatment.
• The study highlighted the importance of increasing subject pool sizes and pooling data to draw more reliable conclusions, ultimately establishing PRP as a more effective and safer treatment compared to AB and corticosteroids.
Study Reference:
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: systematic review and network meta-analysis. Journal of Orthopedic Traumatology, 17(2), 101-112. DOI: 10.1007/s10195-015-0376-5
