The effect of leucocyte concentration of platelet-rich plasma on outcomes in patients with lateral epicondylitis: a systematic review and meta-analysis
التفاصيل البيبلوغرافية
العنوان:
The effect of leucocyte concentration of platelet-rich plasma on outcomes in patients with lateral epicondylitis: a systematic review and meta-analysis
HYPOTHESIS The concentration of leukocytes influences the quality of platelet-rich plasma (PRP). However, there is no consensus on which type of PRP based on the concentration of leukocytes is the best for lateral epicondylitis (LE). METHODS We systematically searched the MEDLINE, Embase, and Cochrane Library databases up to March 1, 2020. Studies involving randomized controlled trials (RCTs), patients with LE, and treatment with PRP injections were included. PRP was classified into leukocyte-poor (LP)-PRP and leukocyte-rich (LR)-PRP. LR-PRP was defined as PRP with a white blood cell (WBC) concentration exceeding that of whole blood (4.0-10.0 per uL3), while LP-PRP was defined as PRP with a lower WBC concentration than whole blood. The efficacy of PRP was assessed using the visual analog scale (VAS) and success rates. RESULTS Eleven RCTs (six LP-PRP and five LR-PRP) were eligible for inclusion in this review. Eight studies were included in the meta-analysis to evaluate the VAS score. Regarding short-term follow-up, there was no difference in the VAS scores between the LP-PRP and control groups (standard mean difference [SMD], 0.01; 95% confidence interval [CI], -0.29-0.30; p=0.97), with no heterogeneity (I2=0%). There was also no difference in the VAS scores between the LR-PRP and control groups (SMD, -0.19; 95% CI, -0.57-0.20; p=0.34), with substantial heterogeneity (I2=56.7%). Regarding long-term follow-up, there was no difference in the VAS scores between the LP-PRP and control groups (SMD, -0.73; 95% CI, -1.69-0.23; p=0.134) with substantial heterogeneity (I2=88.4%). The LR-PRP groups had lower VAS scores than the control groups (SMD, -1.06; 95% CI, -2.02--0.09; p=0.032), with substantial heterogeneity (I2=92%). In the LP-PRP group, there was no significant difference in the success rate (odds ratio [OR], 1.08; 95% CI, 0.07-16.47; p=0.956) with substantial heterogeneity (I2=87.7%). In the LR-PRP group, however, the patients who received PRP had a higher success rate than those in the control group (OR, 2.85; 95% CI, 1.67-4.85; p