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Platelet-Rich Plasma Injections Versus Surgery for Treating Lateral Epicondylitis, Placebo Versus Placebo?

      The conclusion of Hardy et al. that platelet-rich plasma (PRP) injections are an alternative to surgery for enthesopathy of the origin of the extensor carpi radialis brevis (eECRB; lateral epicondylitis) is misleading.
      • Hardy R.
      • Tori A.
      • Fuchs H.
      • Larson T.
      • Brand J.
      • Monroe E.
      To improve pain and function, platelet-rich plasma injections may be an alternative to surgery for treating lateral epicondylitis: A systematic review.
      Enthesopathy of the eECRB is a self-limited condition.
      • Ikonen J.
      • Lahdeoja T.
      • Ardern C.L.
      • Buchbinder R.
      • Reito A.
      • Karjalainen T.
      Persistent tennis elbow symptoms have little prognostic value: A systematic review and meta-analysis.
      You could treat it with anything or nothing and people will feel better. There are other nonspecific effects, such as regression to the mean and placebo effects. Comparisons of surgery to simulated surgery (placebo) or to treatments have shown to be no better than placebo.
      • Yoon S.Y.
      • Kim Y.W.
      • Shin I.S.
      • Moon H.I.
      • Lee S.C.
      Does the type of extracorporeal shock therapy influence treatment effectiveness in lateral epicondylitis? A systematic review and meta-analysis.
      • Defoort S.
      • De Smet L.
      • Brys P.
      • Peers K.
      • Degreef I.
      Lateral elbow tendinopathy: Surgery versus extracorporeal shock wave therapy.
      • Kroslak M.
      • Murrell G.A.C.
      Surgical treatment of lateral epicondylitis: A prospective, randomized, double-blinded, placebo-controlled clinical trial.
      Two recent meta-analyses concluded that PRP injections were no better than placebo.
      • Gao B.
      • Dwivedi S.
      • DeFroda S.
      • et al.
      The therapeutic benefits of saline solution injection for lateral epicondylitis: A meta-analysis of randomized controlled trials comparing saline injections with nonsurgical injection therapies.
      • Simental-Mendía M.
      • Vilchez-Cavazos F.
      • Álvarez-Villalobos N.
      • et al.
      Clinical efficacy of platelet-rich plasma in the treatment of lateral epicondylitis: A systematic review and meta-analysis of randomized placebo-controlled clinical trials.
      On the basis of the available evidence, the more accurate conclusion may be that neither PRP treatment nor surgery are superior to placebo.

      Supplementary Data

      References

        • Hardy R.
        • Tori A.
        • Fuchs H.
        • Larson T.
        • Brand J.
        • Monroe E.
        To improve pain and function, platelet-rich plasma injections may be an alternative to surgery for treating lateral epicondylitis: A systematic review.
        Arthroscopy. 2021; 37: 3360-3367
        • Ikonen J.
        • Lahdeoja T.
        • Ardern C.L.
        • Buchbinder R.
        • Reito A.
        • Karjalainen T.
        Persistent tennis elbow symptoms have little prognostic value: A systematic review and meta-analysis.
        Clin Orthop Relat Res. 2022; 480: 647-660
        • Yoon S.Y.
        • Kim Y.W.
        • Shin I.S.
        • Moon H.I.
        • Lee S.C.
        Does the type of extracorporeal shock therapy influence treatment effectiveness in lateral epicondylitis? A systematic review and meta-analysis.
        Clin Orthop Relat Res. 2020; 478: 2324-2339
        • Defoort S.
        • De Smet L.
        • Brys P.
        • Peers K.
        • Degreef I.
        Lateral elbow tendinopathy: Surgery versus extracorporeal shock wave therapy.
        Hand Surg Rehabil. 2021; 40: 263-267
        • Kroslak M.
        • Murrell G.A.C.
        Surgical treatment of lateral epicondylitis: A prospective, randomized, double-blinded, placebo-controlled clinical trial.
        Am J Sports Med. 2018; 46: 1106-1113
        • Gao B.
        • Dwivedi S.
        • DeFroda S.
        • et al.
        The therapeutic benefits of saline solution injection for lateral epicondylitis: A meta-analysis of randomized controlled trials comparing saline injections with nonsurgical injection therapies.
        Arthroscopy. 2019; 35: 1847-1859.e12
        • Simental-Mendía M.
        • Vilchez-Cavazos F.
        • Álvarez-Villalobos N.
        • et al.
        Clinical efficacy of platelet-rich plasma in the treatment of lateral epicondylitis: A systematic review and meta-analysis of randomized placebo-controlled clinical trials.
        Clin Rheumatol. 2020; 39: 2255-2265