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Review
. 2021 May 21:19:96-107.
doi: 10.1016/j.jcot.2021.05.020. eCollection 2021 Aug.

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  1 , Sandeep Patel  2 , Preethi Selvaraj  3 , Madhan Jeyaraman  4
Affiliations
Review

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 et al. J Clin Orthop Trauma. .

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.

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Conflict of interest statement

On behalf of all authors, corresponding author declares no conflict of interest.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of the included studies.
Fig. 2
Fig. 2
Methodological quality and risk of bias assessment of all the included studies.
Fig. 3
Fig. 3
Forest plot of the included studies stratified based on the nature of PRP used for VAS outcome at final follow-up.
Fig. 4
Fig. 4
Forest plot of the included studies stratified based on the nature of PRP used for DASH score outcome at final follow-up.
Fig. 5
Fig. 5
Forest plot of the included studies stratified based on the nature of PRP used for PRETEE score outcome at final follow-up.
Fig. 6
Fig. 6
Forest plot of the included studies describing MEPS outcome at final follow-up.
Fig. 7
Fig. 7
Forest plot of the included studies comparing the safety of PRP therapy to the controls in lateral epicondylitis by adverse events reported in the included studies.
Fig. 8
Fig. 8
Forest plot of the subgroup analysis of the included studies comparing the role of single and multiple doses of PRP therapy in lateral epicondylitis.
Fig. 9
Fig. 9
Publication bias assessment with Funnel plot, Galbraith plot for VAS outcome of the included studies.
Fig. 10
Fig. 10
Chronology of use of type of PRP noted in the included studies.
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