Platelet-rich plasma therapy ensures pain reduction in the management of lateral epicondylitis – a PRISMA-compliant network meta-analysis of randomized controlled trials

ABSTRACT
Objectives: Analyze the effectiveness of PRP therapy in comparison to other available treatments in the management of lateral epicondylitis (LE). Materials and methods: We conducted electronic database searches in PubMed, Embase, Web of
Science, and Cochrane Library until June 2021 for RCTs analyzing the efficacy of PRP in the manage- ment of LE. VAS for pain, DASH score, and PRETEE score were the outcomes analyzed. The analysis was performed in R-platform using MetaInsight and interventions were ranked based on p-score approach. Cochrane’s CINeMA approach was used for quality appraisal. Results: Twenty-five RCTs with 2040 patients were included in the network analysis. Compared to saline
control, only leukocyte-rich-PRP resulted in significant pain relief (WMD=−14.8,95% CI [−23.18,-6.39];low confidence) compared to steroid, local anesthetic, laser, and surgery. On analyzing DASH scores and PRETEE scores, none of the above-mentioned treatment methods were superior to saline control. In subgroup analysis, leucocyte-rich-PRP resulted in clinically significant improvement. Leucocyte-rich-PRP seems more promising with p-score of 0.415. Conclusion: PRP therapy offers significant pain relief compared to saline control in the management of LE without similar improvement in functional outcome. With available low-quality evidence, PRP was
the most promising therapy that needs further exploration to explore its usefulness in lateral epicondylitis.