Platelet-rich plasma and corticosteroid injection for tendinopathy: a systematic review and meta-analysis

Abstract

Objective: In this systematic review and meta-analysis, we evaluated and compared the efficacy and safety of platelet-rich plasma injection into corticosteroid injection in the treatment of tendinopathy.

Methods: We searched PUBMED, EMBASE, Cochrane Library, SCOPUS, and Web of Science to identify randomized controlled trials on the PRP injection versus CS injection in treatment of tendinopathy.The meta-analysis was performed using the Revman 5.4 software.

Result: We found 27 RCT studies with a total of 1779 patients enrolled. 8 rotator cuff injuries, 7 humeral external epicondylitis, 10 plantar fasciitis, and 2 tenosynovitis. The results of the meta-analysis showed that there were no significant group differences in the results of patients with rotator cuff injury comparing the pain visual analog scale score and functional measures at 1 month after receiving injection treatment. After three months of receiving PRP treatment, the VAS scores showed greater improvement compared to the CS group(OR = -1.64,95%CI [-2.97,-0.31],P = 0.02), while there was no statistically significant difference in shoulder joint function between the two groups at the 3-6 month post-treatment mark. Patients with plantar fasciitis showed no significant differences in VAS and AOFAS scores after receiving PRP or CS injections at 1 and 3 months. However, at the 6-month mark, the PRP group demonstrated significantly better VAS and AOFAS scores compared to the CS group(OR = -1.41,95%CI [-1.88,-0.44],P < 0.00001; OR = 7.19,95%CI [2.41,11.91],P = 0.003). 1 month after CS injection in patients with tenosynovitis, the VAS score was lower than that of the PRP group; patients with elbow epicondylitis had better improved upper limb function rating scale scores 1 month after CS injection compared to the PRP group. In patients with tenosynovitis, the VAS scores were superior to the CS group six months after PRP treatment(OR = -0.72,95%CI [-1.04,-0.40],P < 0.00001); similarly, patients with lateral epicondylitis exhibited better VAS, DASH scores than the CS group three and twelve months post-PRP treatment(OR = -9.76,95%CI [-10.89,-8.63],P = 0.0002; OR = -0.97,95%CI [-1.87,-0.06],P < 0.0001; OR = -18.03,95%CI [-31.61,-4.46],P = 0.009).

Conclusion: PRP can effectively improve pain and functional impairment in patients with tendinopathy, and its mid-term efficacy is superior to that of corticosteroids. However, the long-term efficacy remains to be further clinically verified.

Keywords: Corticosteroid; Meta-analysis; Platelet-rich plasma; Systematic review; Tendinopathies.

Fig. 1

Flow chart

Fig. 2

Risk of bias graph

Fig. 3

Risk of bias summary

Fig. 4

Forest plot. Rotator cuff tendinopathy. Outcomes: visual analog scale score for pain, and shoulder functional questionnaires. PRP: platelet-rich plasma; CS: corticosteroid; SD: standard deviation; 95%CI: 95% confidence interval

Fig. 5

Forest plot.humeral external epicondylitis. Outcomes: visual analog scale score for pain, and Disabilities of the Arm, Shoulder and Hand. PRP: platelet-rich plasma; CS: corticosteroid; SD: standard deviation; 95%CI: 95% confidence interval

Fig. 6

Forest plot. plantar fasciitis. Outcomes: visual analog scale score for pain, and Ankle Hindfood Scale. PRP: platelet-rich plasma; CS: corticosteroid; SD: standard deviation; 95%CI: 95% confidence interval

Fig. 7

Forest plot. tenosynovitis. Outcomes: visual analog scale score for pain, and Ankle Hindfood Scale. PRP: platelet-rich plasma; CS: corticosteroid; SD: standard deviation; 95%CI: 95% confidence interval

Fig. 8

Forest plot. Outcome: treatment response and adverse events. PRP: platelet-rich plasma; CS: corticosteroid; M-H: Mantel–Haenszel; 95%CI: 95% confidence interval

Fig. 9

Sensitivity analysis for efficiency

Fig. 10

The funnel plot for the efficiency