Treatment with plasma rich in platelets in lateral epicondylitis: Systematic Review

Introduction: Therapies using platelet-rich plasma (PRP) are becoming widely used, especially in sports medicine, where early return to function is a major concern. Assuming these therapies are based on a biological stimulus that accelerates the recovery of degenerated tissues, thus allowing for an early return to activities, their use has spread to a multitude of orthopedic pathologies, but clear proof of their clinical effectiveness isyet to be demonstrated . For these reasons, the present study aimed to evaluate, through a systematic review, the use of platelet-rich plasma in the treatment of lateral epicondylitis of the elbow. Methods: Two reviewers independently performed a search with the same descriptors and in the Pubmed, Medline and Embase databases, for studies published until July 2, 2019. The following descriptors were used: “Lateral epicondylar tendinopathy”; “Treatment”; “Plateletrich plasma”; “Efficacy”. The following filters were used to reach the expected final result: “Randomized Controlled Trial”; “Randomized Clinical Trial”; “MetaAnalysis”; “Systematic Reviews”; “Clinical Trial”; “Cohort”. Results: There was a very strong correlation between the searches of the two researchers (k=0.801) In the end, 36 complete studies remained, of which 20 were included. As general characteristics, a total of 819 patients treated with Platelet Rich Plasma (PRP) were included in this review. Mean age, dominant side, and disease duration ranged from 34 to 50 years, 57 to 85%, and 5 to 18 months, respectively. The percentage of men ranged from 18 to 57%. The average satisfaction rate was 86%, and complications were reported with an average of 6.02%. Heterogeneity was observed in relation to the study design. The selected articles presented the following characteristics: randomized clinical study, meta-analysis, systematic review and cohort study. The predominance in the literature surveyed was the absence of a gold standard in the treatment of lateral elbow epicondylitis, even with positive results in most studies that used PRP. Conclusion: In this review, it was evidenced that medical advances in using PRP therapy are a reality, the clinical results presented by the studies do not demonstrate consensus on its effectiveness and do not guarantee the success of the therapy in face of side effects such as pain. However, its results are promising. Further studies with level of evidence I and II, in number of relevant patients, are still needed to definitively answer this question.