title: Platelet-rich plasma versus autologous blood versus steroid injection in lateral epicondylitis: systematic review and network meta-analysis.
abstract: BACKGROUND
  Clinical outcomes between the use of platelet-rich plasma (PRP), autologous blood (AB) and corticosteroid (CS) injection in lateral epicondylitis are still controversial.
  
  
  METHODS
  A systematic review and network meta-analysis of randomized controlled trials was conducted with the aim of comparing relevant clinical outcomes between the use of PRP, AB and CS injection. Medline and Scopus databases were searched from inception to January 2015. A network meta-analysis was performed by applying weight regression for continuous outcomes and a mixed-effect Poisson regression for dichotomous outcomes.
  
  
  RESULTS
  Ten of 374 identified studies were eligible. When compared to CS, AB injection showed significantly improved effects with unstandardized mean differences (UMD) in pain visual analog scale (VAS), Disabilities of Arm Shoulder and Hand (DASH), Patient-Related Tennis Elbow Evaluation (PRTEE) score and pressure pain threshold (PPT) of -2.5 (95 % confidence interval, -3.5, -1.5), -25.5 (-33.8, -17.2), -5.3 (-9.1, -1.6) and 9.9 (5.6, 14.2), respectively. PRP injections also showed significantly improved VAS and DASH scores when compared with CS. PRP showed significantly better VAS with UMD when compared to AB injection. AB injection has a higher risk of adverse effects, with a relative risk of 1.78 (1.00, 3.17), when compared to CS. The network meta-analysis suggested no statistically significant difference in multiple active treatment comparisons of VAS, DASH and PRTEE when comparing PRP and AB injections. However, AB injection had improved DASH score and PPT when compared with PRP injection. In terms of adverse effects, AB injection had a higher risk than PRP injection.
  
  
  CONCLUSIONS
  This network meta-analysis provided additional information that PRP injection can improve pain and lower the risk of complications, whereas AB injection can improve pain, disabilities scores and pressure pain threshold but has a higher risk of complications.
  
  
  METHODS
  Level I evidence.
authors.affiliation: Orthopedics Department, Police General Hospital, Bangkok, Thailand.
authors.forename: Alisara
authors.initials: A
authors.lastname: Arirachakaran
authors.affiliation: Orthopedics Department, Police General Hospital, Bangkok, Thailand.
authors.forename: Amnat
authors.initials: A
authors.lastname: Sukthuayat
authors.affiliation: Orthopedics Department, Police General Hospital, Bangkok, Thailand.
authors.forename: Thaworn
authors.initials: T
authors.lastname: Sisayanarane
authors.affiliation: Orthopedics Department, Police General Hospital, Bangkok, Thailand.
authors.forename: Sorawut
authors.initials: S
authors.lastname: Laoratanavoraphong
authors.affiliation: Orthopedics Department, Lerdsin General Hospital, Bangkok, Thailand.
authors.forename: Wichan
authors.initials: W
authors.lastname: Kanchanatawan
authors.affiliation: Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Bangkok, Thailand. Jatupon_kong@hotmail.com.
authors.forename: Jatupon
authors.initials: J
authors.lastname: Kongtharvonskul
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use*; D004185:Disability Evaluation; D006801:Humans; D007267:Injections; D059408:Pain Management; D010147:Pain Measurement; D053657:Platelet-Rich Plasma; D016032:Randomized Controlled Trials as Topic; D013716:Tennis Elbow / Q000628:therapy*
chemical_list: D000305:Adrenal Cortex Hormones
keywords: Autologous blood; Corticosteroid; Lateral epicondylitis; Network meta-analysis; PRP; Systematic review