The effect of platelet-rich plasma on clinical outcomes in lateral epicondylitis.
OBJECTIVE
To evaluate the evidence for application of platelet-rich plasma (PRP) in lateral epicondylitis.


METHODS
We carried out a systematic review of the current evidence on the effects of PRP in lateral epicondylitis on clinical outcomes. We performed a comprehensive search of the PubMed, Medline, Cochrane, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Embase databases using various combinations of the commercial names of each PRP preparation and "lateral epicondylitis" (with its associated terms), looking specifically at human studies. Data validity was assessed and collected on clinical outcome.


RESULTS
Nine studies met the inclusion criteria, of which 5 were randomized controlled trials. Two cohort studies showed that PRP improved clinical satisfaction scores. One case-control study showed that PRP yielded a significantly greater improvement in symptoms compared with bupivacaine. Two randomized controlled trials compared the effect of injections of PRP and blood. Only 1 of the studies noted a significant difference at the 6-week time point. Three randomized controlled trials compared corticosteroids with PRP. Two of the smaller trials, which had follow-up periods of 6 weeks and 3 months, showed no significant difference between treatment groups. The largest randomized controlled trial found that PRP had significant benefit compared with corticosteroids with regard to pain and Disabilities of the Arm, Shoulder and Hand scores at 1- and 2-year time points.


CONCLUSIONS
This review highlights the limited but evolving evidence for the use of PRP in lateral epicondylitis; however, further research is required to understand the concentration and preparation that facilitate the best clinical outcome. Characterizing the timing of the intervention would optimize the health economics behind the decision to treat for the patient and health care provider.


METHODS
Level III, systematic review of Level I to III studies.
Department of Orthopaedics, Norfolk and Norwich University Hospital, Norwich, England. Electronic address: zafar.ahmad@doctors.org.uk.
Zafar
Z
Ahmad
Roger
R
Brooks
Sertaz-Niel
SN
Kang
Holly
H
Weaver
Ian
I
Nunney
Graham
G
Tytherleigh-Strong
Neil
N
Rushton
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D018771:Arthralgia / Q000209:etiology / Q000628:therapy; D019317:Evidence-Based Medicine; D006801:Humans; D053657:Platelet-Rich Plasma; D013716:Tennis Elbow / Q000150:complications / Q000628:therapy*; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones