| Reference | Study type | Population | Intervention and comparison | Outcomes | Risk of bias |
|---|---|---|---|---|---|
| «Simental-Mendía M, Vilchez-Cavazos F, Álvarez-Vill...»1 | SR/MA | RCTs with placebo control group for adults > 18 yrs with epicondylitis, minimum evolution time of 3 months, and a minimum follow-up of 2 months (5 studies, 276 patients) | PRP or any derivative (autologous conditioned plasma, plasma rich in growth factors, platelet-rich fibrin) n=153 compared with saline n=123 | Pain (VAS), patient-rated tennis elbow evaluation (PRTEE), and functional improvement (PRTEE, DASH), Roles-Maudsley score | Low/moderate |
| «Karjalainen TV, Silagy M, O'Bryan E ym. Autologous...»2 | SR/MA | 32 RCTs and quasi-RCTs with 2337 patients comparing autologous whole blood or PRP injection therapy to another therapy (placebo or active treatment, including non-pharmacological therapies, and comparison between PRP and autologous blood) for lateral elbow pain. Of the patients 56% were females. Mean age varied between 36 and 53 years. Duration of symptoms ranged from 1 to 22 months. | Autologous whole blood or PRP injection therapy vs. another therapy (placebo or active treatment, including non-pharmacological therapies, and comparison between PRP and autologous blood) |
pain relief (≥ 30% or ≥ 50%), mean pain, mean function, treatment success, quality of life, withdrawal due to adverse events, and adverse events; the primary time point was three months | Moderate |
RCT=randomized controlled trial; SR=systematic review; MA=meta-analysis; PRP=platelet-rich plasma group
| Reference | Comments |
|---|---|
| «Simental-Mendía M, Vilchez-Cavazos F, Álvarez-Vill...»1 | Low risk of bias according to random sequence generation and selective reporting.
4/5 had insufficient information about allocation concealment. One study lacked information
with blinding. 4/5 had unclear risk of bias due to sponsoring from companies that
develop PRP devices. When one study was excluded, (n=18+18), total mean difference was -0.06 (95% CI -0.76, 0.64) and I2 was 0. There is evidence that saline injection have relevant clinical effect on pain and functional scores. |
| «Karjalainen TV, Silagy M, O'Bryan E ym. Autologous...»2 | Most studies were at risk of selection, performance, and detection biases, mainly
due to inadequate allocation concealment and lack of participant blinding. Pain and
function analysis included 8 studies, but one study compared autologous blood with
glukocorticoid or saline. Of the 7 PRP studies, 3 had saline as placebo and 4 had
local anesthetic as placebo. Of the PRP studies, 3 had 3 intervention arms. In ref. 1, of the 4 studies in pain analysis, 1 were not included in ref. 2, but in the analysis of function in ref. 1, all the 3 studies were also included in ref. 2. |
Results
| Reference | Number of studies and number of patients (I/C) | Follow-up time | Standardized mean difference, (95% CI) |
|---|---|---|---|
| «Simental-Mendía M, Vilchez-Cavazos F, Álvarez-Vill...»1 | 4 (135/105) | 2–12 months | SMD -0.53 (-1.32–0.27) |
| «Karjalainen TV, Silagy M, O'Bryan E ym. Autologous...»2 | 8 (523 tot.) 5 (241 tot.) |
> 6 weeks–3 months > 6–12 months |
MD -0.16 (-0.60–0.29) -0.69 (-1.78–0.39) |
I= intervention; C=comparison; CI=confidence interval
| Reference | Number of studies and number of pataients (I/C) | Follow-up time | Std mean difference IV, Random, 95% CI |
|---|---|---|---|
| «Simental-Mendía M, Vilchez-Cavazos F, Álvarez-Vill...»1 |
3 (63/63) |
2–12 months |
SMD -0.07 (-0.46–0.33) |
| «Karjalainen TV, Silagy M, O'Bryan E ym. Autologous...»2 |
8 (502 tot.) 4 (203 tot.) |
> 6 weeks–3 months > 6–12 months |
MD -1.86 (-4,9–1,25) -5.81 (-16.66–5.05) |
I=intervention; C=comparison; CI=confidence interval