Comparative analysis of leucocyte poor vs leucocyte rich platelet-rich plasma in the management of lateral epicondylitis: Systematic review & meta-analysis of randomised controlled trials

Sathish Muthu; Sandeep Patel; Preethi Selvaraj; Madhan Jeyaraman

doi:10.1016/j.jcot.2021.05.020

Comparative analysis of leucocyte poor vs leucocyte rich platelet-rich plasma in the management of lateral epicondylitis: Systematic review & meta-analysis of randomised controlled trials

J Clin Orthop Trauma. 2021 May 21:19:96-107. doi: 10.1016/j.jcot.2021.05.020. eCollection 2021 Aug.

Authors

Sathish Muthu¹, Sandeep Patel², Preethi Selvaraj³, Madhan Jeyaraman⁴

Affiliations

¹ Orthopaedic Research Group, Coimbatore, Tamil Nadu, India.
² Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
³ Department of Community Medicine, SRM Medical College Hospital and Research Centre, SRM University Chennai, Tamil Nadu, India.
⁴ Department of Orthopaedics, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India.

Abstract

Study design: Systematic Review & Meta-analysis.

Objectives: We aim to comparatively analyse the efficacy and safety of using leucocyte-poor platelet rich plasma (LP-PRP) against leucocyte-rich platelet rich plasma (LR-PRP) in the management of lateral epicondylitis.

Materials and methods: We conducted independent and duplicate electronic database searches including PubMed, Embase, Web of Science and Cochrane Library till September 2020 for randomised controlled trials analyzing the efficacy and safety of LP-PRP and LR-PRP in the management of lateral epicondylitis. Visual Analog Score(VAS) for pain, Disabilities of the Arm, Shoulder and Hand (DASH) Score, Patient Reported Tennis-Elbow Evaluation (PRETEE) Score, Mayo Elbow Performance Score(MEPS) and adverse events were the outcomes analyzed. Analysis was performed in R-platform using OpenMeta[Analyst] software.

Results: We performed a single arm meta-analysis of 26 studies involving 2034 patients. On analysis it was noted that significant improvement was noted in the VAS for pain (p < 0.001), DASH score (p < 0.001), PRETEE score (p < 0.001) and MEPS (p < 0.027) compared to their pre-operative state. No significant increase in adverse events were noted compared to the control group (p = 0.170). While stratifying the results based on the type of PRP used, no significant difference was noted between the use of LP-PRP or LR-PRP in any of the above-mentioned outcome measures.

Conclusion: PRP is a safe and effective treatment option for lateral epicondylitis with clinical improvements in pain and functional scores and both types of PRP (LR-PRP & LP-PRP) offer similar results.

Keywords: Lateral epicondylitis; Meta analysis; Platelet rich plasma; Systematic review.

Publication types

Review