A systematic review of four injection therapies for lateral epicondylosis: prolotherapy, polidocanol, whole blood and platelet-rich plasma.
OBJECTIVE
To appraise existing evidence for prolotherapy, polidocanol, autologous whole blood and platelet-rich plasma injection therapies for lateral epicondylosis (LE).


METHODS
Systematic review.


METHODS
Medline, Embase, CINAHL, Cochrane Central Register of Controlled Trials, Allied and Complementary Medicine.


METHODS
names and descriptors of the therapies and LE.


METHODS
All human studies assessing the four therapies for LE.


RESULTS
Results of five prospective case series and four controlled trials (three prolotherapy, two polidocanol, three autologous whole blood and one platelet-rich plasma) suggest each of the four therapies is effective for LE. In follow-up periods ranging from 9 to 108 weeks, studies reported sustained, statistically significant (p<0.05) improvement in visual analogue scale primary outcome pain score measures and disease-specific questionnaires; relative effect sizes ranged from 51% to 94%; Cohen's d ranged from 0.68 to 6.68. Secondary outcomes also improved, including biomechanical elbow function assessment (polidocanol and prolotherapy), presence of abnormalities and increased vascularity on ultrasound (autologous whole blood and polidocanol). Subjects reported satisfaction with therapies on single-item assessments. All studies were limited by small sample size.


CONCLUSIONS
There is strong pilot-level evidence supporting the use of prolotherapy, polidocanol, autologous whole blood and platelet-rich plasma injections in the treatment of LE. Rigorous studies of sufficient sample size, assessing these injection therapies using validated clinical, radiological and biomechanical measures, and tissue injury/healing-responsive biomarkers, are needed to determine long-term effectiveness and safety, and whether these techniques can play a definitive role in the management of LE and other tendinopathies.
Rabago
D
D
University of Wisconsin School of Medicine and Public Health, Department of Family Medicine, 777 S. Mills St, Madison WI 53715, USA. david.rabago@fammed.wisc.edu
Best
T M
TM
Zgierska
A E
AE
Zeisig
E
E
Ryan
M
M
Crane
D
D
D001804:Blood Transfusion, Autologous / Q000379:methods*; D006801:Humans; D007267:Injections; D009324:Naturopathy / Q000379:methods*; D053657:Platelet-Rich Plasma; D000077423:Polidocanol; D011092:Polyethylene Glycols / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012597:Sclerosing Solutions / Q000627:therapeutic use*; D013716:Tennis Elbow / Q000628:therapy*
D012597:Sclerosing Solutions; D000077423:Polidocanol; D011092:Polyethylene Glycols