Orthopedic & Muscular System: Current Research
Open Access

Abstract

A Systematic Review to Compare Three Injection Modalities in the Management of Pain and Function for Patients with Chronic Lateral Epicondylalgia

Mohammed Elmajee, Lynne Gaskell, Adam Watts, Munir Khan, Mostafa Elmajee* and Housameldin Raslan

Aim: To provide an evidence-based scientific report on the efficacy of three common injection treatment modalities for Lateral Epicondylalgia (LE). These injections are contemporary and frequently used in clinical practice.

Objective: To systematically locate and appraise RCTs (Randomised Controlled Trials) of three comparative injection modalities (Corticosteroid Injection (CSI), Platelets Rich Plasma (PRP), and Autologous Blood Injection (ABI) and to review their efficacy in the management of pain and dysfunction associated with LE.

Search strategy: RCTs that compare at least two of the three injections modalities and published from January 2005 to September 2015 were systematically searched. The following online search engines were utilised: The Cochrane Central Register of Controlled Trials (Central), Web of Sciences, PubMed, CINAHL, MEDLINE, and Academic Search Premier. The following search terms were used: “tennis elbow”, “lateral epicondylitis”, “corticosteroid injection”, “autologous blood injection”, “platelets rich plasma” and “randomised controlled trial”. The terms “tennis elbow” or “lateral epicondylitis” or “lateral epicondylalgia” were combined with each one of the injection modalities and the term “randomised controlled trial”. Methodological assessment was conducted by applying Sign 50 tool and The Cochrane Collaboration’s tool for assessing risk of bias. This systematic review protocol was conducted according to the standards presented in the Cochrane Handbook and recommendations in the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) statement.

Results: Seven RCTs were included within this review. Overall methodological quality was high, mostly level I studies. Three RCTs compared the effects of PRP and ABI, three studies concerned the comparison between PRP and CSI, and one RCT related to the effectiveness of ABI and CSI.

Conclusion: Corticosteroid injections failed to demonstrate long-lasting significant clinical effects in chronic LE. However, PRP and ABI were shown to have a progressive and increasing effect from 6 months to one year following the injections. PRP and ABI demonstrated comparable effects in terms of pain and function. Further studies are warranted to justify the higher costs associated with the use of PRP.