title: Injection therapies for lateral epicondylalgia: a systematic review and Bayesian network meta-analysis.
abstract: BACKGROUND
  There are many injection therapies for lateral epicondylalgia but there has been no previous comprehensive comparison, based on the Bayesian method.
  
  
  METHODS
  The MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched for appropriate literature. The outcome measurement was the pain score. Direct comparisons were performed using the pairwise meta-analysis, and network meta-analysis, based on a Bayesian model, was used to calculate the results of all of the potentially possible comparisons and rank probabilities. A sensitivity analysis was performed by excluding low-quality studies. The inconsistency of the model was assessed by means of the node-splitting method. Metaregression was used to assess the relationship between the sample size and the treatment effect.
  
  
  RESULTS
  All of the injection treatments showed a trend towards better effects than placebo. Additionally, the peppering technique did not add additional benefits when combined with other treatments. No significant changes were observed by excluding low-quality studies in the sensitivity analysis. No significant inconsistencies were found according to the inconsistency analysis, and metaregression revealed that the sample size was not associated with the treatment effects.
  
  
  CONCLUSIONS
  Some commonly used injection therapies can be considered treatment candidates for lateral epicondylalgia, such as botulinum toxin, platelet-rich plasma and autologous blood injection, but corticosteroid is not recommended. Hyaluronate injection and prolotherapy might be more effective, but their superiority must be confirmed by more research. The peppering technique is not helpful in injection therapies.
authors.affiliation: Department of Orthopedic and Trauma Surgery, Central Hospital of PetroChina, Langfang, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Dong
authors.affiliation: Department of Orthopedic and Trauma Surgery, Hospital Wermelskirchen, Wermelskirchen, Germany.
authors.forename: Hans
authors.initials: H
authors.lastname: Goost
authors.affiliation: Department of Orthopedic and Trauma Surgery, Rizhao People's Hospital, Rizhao, China.
authors.forename: Xiang-Bo
authors.initials: XB
authors.lastname: Lin
authors.affiliation: Department of Orthopedic and Trauma Surgery, University Hospital Bonn, Bonn, Germany.
authors.forename: Christof
authors.initials: C
authors.lastname: Burger
authors.affiliation: Department of Orthopedic and Trauma Surgery, Evangelic Wald-Krankenhaus, Bonn, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Paul
authors.affiliation: Department of Orthopedic and Trauma Surgery, Central Hospital of PetroChina, Langfang, China.
authors.forename: Zeng-Li
authors.initials: ZL
authors.lastname: Wang
authors.affiliation: Department of Orthopedic and Trauma Surgery, Central Hospital of PetroChina, Langfang, China.
authors.forename: Fan-Lin
authors.initials: FL
authors.lastname: Kong
authors.affiliation: Department of Orthopedic and Trauma Surgery, University Hospital Bonn, Bonn, Germany.
authors.forename: Kristian
authors.initials: K
authors.lastname: Welle
authors.affiliation: Department of Fundamental Science, North China Institute of Aerospace Engineering, Langfang, China.
authors.forename: Zhi-Chao
authors.initials: ZC
authors.lastname: Jiang
authors.affiliation: Department of Orthopedic and Trauma Surgery, University Hospital Bonn, Bonn, Germany.
authors.forename: Koroush
authors.initials: K
authors.lastname: Kabir
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D018771:Arthralgia / Q000188:drug therapy*; D001499:Bayes Theorem; D006801:Humans; D007270:Injections, Intra-Articular; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D013716:Tennis Elbow / Q000188:drug therapy*; D057832:Watchful Waiting; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents
keywords: Meta-analysis; Randomised controlled trial; Review; Tennis elbow; Treatment