Elbow epicondylitis and plantar fasciitis: platelet-rich plasma vs corticosteroid injections

  • Huang K & al.
  • Am J Sports Med
  • 10 Dec 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • Platelet-rich plasma (PRP) injections provide statistically and clinically meaningful improvements in long-term pain and function in patients with elbow epicondylitis (EE) and plantar fasciitis (PF), respectively.
  • Corticosteroid (CS) injections demonstrated statistically meaningful but not clinically significant short-term reduction in pain scores for EE.

Why this matters

  • EE and PF are common problems in mid-life with both affecting patient health, sporting activities, and work.
  • Limited data exist regarding the clinical efficacy of PRP vs CS in EE and PF.

Study design

  • Meta-analysis of 20 studies including 1268 participants (17 randomised controlled trials [RCTs] and 3 prospective cohort studies) compared the efficacy of PRP and CS injections in EE and PF.
  • Primary outcomes: pain and function in the short term (1-3 months) and long term (≥6 months).
  • Funding: National Natural Science Foundation of China; others.

Key results

  • In the treatment of EE:
    • PRP vs CS injections showed (a very low quality of evidence [QOE]) clinically meaningful long-term pain improvement (visual analogue scale [VAS]; standardised mean difference [SMD], −1.3; 95% CI, −1.9 to −0.7; I2=85%) and large effect size (Z=4.24; P<.0001 low-quality evidence>
    • Compared with PRP, CS showed short-term pain improvement (VAS; SMD, 0.56; 95% CI, 0.14-0.99; I2=86%) and medium effect size (Z=2.60; P=.009) [moderate quality evidence]
  • In the treatment of PF:
    • PRP vs CS showed long-term pain improvement (American Orthopedic Foot and Ankle Society score; SMD, 1.94; 95% CI, 0.61-3.28; I2=95%) and large effect size (Z=2.85; P=.004) [low quality evidence]
    • Both groups showed no significant difference in terms of short-term pain improvement.

Limitations

  • Low to moderate quality evidence.
  • High heterogeneity across the studies.