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

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: Declarations. Ethics approval and consent to participate: Since our study is a meta-analysis, an Ethical Review Committee Statement is not required. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. 3. Can J Surg. 2022 Sep 21;65(5):E625-E629. doi: 10.1503/cjs.019221. Print 2022 Sep-Oct. Position statement: nonoperative management of lateral epicondylitis in adults. Lapner P(1), Alfonso A(2), Herbert-Davies J(2), Pollock JW(2), Marsh J(2), King G(2); Canadian Shoulder and Elbow Society (CSES). Author information: (1)From the Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ont. (Lapner, Alfonso, Pollock); the Orthopedic Trauma Surgery Clinic at Harborview, Seattle, Wash. (Hebert-Davies); the Pan Am Clinic, Winnipeg, Man. (Marsh); the Section of Orthopaedic Surgery, Department of Surgery, University of Manitoba, Winnipeg, Man. (Marsh); and the Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, Western University, London, Ont. (King) plapner@toh.ca. (2)From the Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ont. (Lapner, Alfonso, Pollock); the Orthopedic Trauma Surgery Clinic at Harborview, Seattle, Wash. (Hebert-Davies); the Pan Am Clinic, Winnipeg, Man. (Marsh); the Section of Orthopaedic Surgery, Department of Surgery, University of Manitoba, Winnipeg, Man. (Marsh); and the Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, Western University, London, Ont. (King). We sought to compare methods of nonsurgical treatment of lateral epicondylitis in men and women older than 18 years to develop a guideline intended for orthopedic surgeons and other health care providers who assess, counsel and care for these patients. We searched Medline, Embase and Cochrane through to Mar. 9, 2021, and included all English-language studies comparing nonsurgical approaches. We compared physiotherapy versus no active treatment, corticosteroids versus placebo, platelet-rich plasma (PRP) versus placebo, and autologous blood injection versus placebo. Outcomes of interest were pain outcomes (visual analogue scale scores) and functional outcomes. We rated the quality of the evidence and strength of recommendations using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. This guideline will benefit patients seeking nonsurgical intervention for lateral epicondylitis by improving counselling on nonsurgical treatment options and possible outcomes. It will also benefit surgical providers by improving their knowledge of various nonsurgical approaches. Data presented could be used to develop frameworks and tools for shared decision-making. Nous avons voulu comparer les méthodes de traitement non chirurgical de l’épicondylite latérale chez des hommes et des femmes de plus de 18 ans pour créer une ligne directrice à l’intention des chirurgiens orthopédistes et autres professionnels de la santé qui évaluent, conseillent et soignent ces patients. Nous avons interrogé les réseaux Medline, Embase et Cochrane jusqu’au 9 mars 2021, et inclus toutes les études de langue anglaise qui comparaient des approches non chirurgicales. Nous avons comparé la physiothérapie à l’abstention de tout traitement actif, la corticothérapie au placebo, le plasma riche en plaquettes (PRP) au placebo et l’injection de sang autologue au placebo. Les paramètres d’intérêt étaient la douleur (échelle analogique visuelle) et le fonctionnement. Nous avons évalué la qualité des données probantes et la solidité des recommandations à l’aide de l’approche GRADE (Grading of Recommendations Assessment, Development, and Evaluation). Cette ligne directrice profitera aux patients qui cherchent une intervention non chirurgicale pour traiter une épicondylite latérale en améliorant les consultations sur les options thérapeutiques non chirurgicales et les résultats escomptés. Elle aidera aussi les chirurgiens orthopédistes en améliorant leurs connaissances sur différentes approches non chirurgicales. Les données présentées pourraient servir à mettre au point des cadres et des outils pour une prise de décision partagée. © 2022 CMA Impact Inc. or its licensors. DOI: 10.1503/cjs.019221 PMCID: PMC9503571