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Review
. 2021 Dec 18;6(2):321-330.
doi: 10.1016/j.jseint.2021.11.010. eCollection 2022 Mar.

Nonoperative treatment of lateral epicondylitis: a systematic review and meta-analysis

Peter Lapner  1 , Ana Alfonso  1 , Jonah Hebert-Davies  2 , J W Pollock  1 , Jonathan Marsh  3   4 , Graham J W King  5 ; Canadian Shoulder and Elbow Society (CSES)
Affiliations
Review

Nonoperative treatment of lateral epicondylitis: a systematic review and meta-analysis

Peter Lapner et al. JSES Int. .

Abstract

Background: There is an ongoing controversy regarding the nonoperative treatment of lateral epicondylitis. Given that the evidence surrounding the use of various treatment options for lateral epicondylitis has expanded, an overall assessment of nonoperative treatment options is required. The purpose of this systematic review and meta-analysis was to compare physiotherapy (strengthening), corticosteroids (CSIs), platelet-rich plasma (PRP), and autologous blood (AB) with no active treatment or placebo control in patients with lateral epicondylitis.

Methods: MEDLINE, Embase, and Cochrane were searched through till March 8, 2021. Additional studies were identified from reviews. All English-language randomized trials comparing nonoperative treatment of patients >18 years of age with lateral epicondylitis were included.

Results: A total of 5 randomized studies compared physiotherapy (strengthening) with no active treatment. There were no significant differences in pain (mean difference: -0.07, 95% confidence interval [CI]: -0.56 to 0.41) or function (standardized mean difference [SMD]: -0.08, 95% CI: -0.46 to 0.30). Seven studies compared CSI with a control. The control group had statistically superior pain (mean difference: 0.70, 95% CI: 0.22 to 1.18) and functional scores (SMD: -0.35, 95% CI: -0.54 to -0.16). Two studies compared PRP with controls, and no differences were found in pain (SD: -0.15, 95% CI: -1.89 to 1.35) or function (SMD: 0.14, 95% CI: -0.45 to 0.73). Three studies compared AB with controls, and no differences were observed in pain (0.49, 95% CI: -2.35 to 3.33) or function (-0.07, 95% CI: -0.64 to 0.50).

Discussion: The available evidence does not support the use of nonoperative treatment options including physiotherapy (strengthening), CSI, PRP, or AB in the treatment of lateral epicondylitis.

Keywords: Autologous blood; Corticosteroids; Lateral epicondylitis; Meta-analysis; Nonoperative treatment; Physiotherapy; Platelet-rich plasma; Systematic review.

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Figures

Figure 1
Figure 1
Flow diagram of search strategy.
Figure 2
Figure 2
Forest plot of physiotherapy versus no active treatment for pain. Risk of bias legend: red dot = high risk of bias; no color = unclear risk; green dot = low risk of bias.
Figure 3
Figure 3
Forest plot of physiotherapy versus no active treatment for function. Risk of bias legend: red dot = high risk of bias; no color = unclear risk; green dot = low risk of bias.
Figure 4
Figure 4
Forest plot of corticosteroids versus no active treatment for pain. Risk of bias legend: red dot = high risk of bias; no color = unclear risk; green dot = low risk of bias.
Figure 5
Figure 5
Forest plot of corticosteroids versus no active treatment for function. Risk of bias legend: red dot = high risk of bias; no color = unclear risk; green dot = low risk of bias.
Figure 6
Figure 6
Forest plot of PRP versus no active treatment for pain. Risk of bias legend: red dot = high risk of bias; no color = unclear risk; green dot = low risk of bias.
Figure 7
Figure 7
Forest plot of PRP versus no active treatment for function. Risk of bias legend: red dot = high risk of bias; no color = unclear risk; green dot = low risk of bias.
Figure 8
Figure 8
Forest plot of AB versus no active treatment for pain. Risk of bias legend: red dot = high risk of bias; no color = unclear risk; green dot = low risk of bias.
Figure 9
Figure 9
Forest plot of AB versus no active treatment for function. Risk of bias legend: red dot = high risk of bias; no color = unclear risk; green dot = low risk of bias.
See this image and copyright information in PMC

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