• Zafar Ahmad, Roger Brooks, Sertaz-Niel Kang, Holly Weaver, Ian Nunney, Graham Tytherleigh-Strong, and Neil Rushton.
• Department of Orthopaedics, Norfolk and Norwich University Hospital, Norwich, England. Electronic address: zafar.ahmad@doctors.org.uk.
• Arthroscopy. 2013 Nov 1;29(11):1851-62.

PurposeTo evaluate the evidence for application of platelet-rich plasma (PRP) in lateral epicondylitis.MethodsWe carried out a systematic review of the current evidence on the effects of PRP in lateral epicondylitis on clinical outcomes. We performed a comprehensive search of the PubMed, Medline, Cochrane, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Embase databases using various combinations of the commercial names of each PRP preparation and "lateral epicondylitis" (with its associated terms), looking specifically at human studies. Data validity was assessed and collected on clinical outcome.ResultsNine studies met the inclusion criteria, of which 5 were randomized controlled trials. Two cohort studies showed that PRP improved clinical satisfaction scores. One case-control study showed that PRP yielded a significantly greater improvement in symptoms compared with bupivacaine. Two randomized controlled trials compared the effect of injections of PRP and blood. Only 1 of the studies noted a significant difference at the 6-week time point. Three randomized controlled trials compared corticosteroids with PRP. Two of the smaller trials, which had follow-up periods of 6 weeks and 3 months, showed no significant difference between treatment groups. The largest randomized controlled trial found that PRP had significant benefit compared with corticosteroids with regard to pain and Disabilities of the Arm, Shoulder and Hand scores at 1- and 2-year time points.ConclusionsThis review highlights the limited but evolving evidence for the use of PRP in lateral epicondylitis; however, further research is required to understand the concentration and preparation that facilitate the best clinical outcome. Characterizing the timing of the intervention would optimize the health economics behind the decision to treat for the patient and health care provider.Level Of EvidenceLevel III, systematic review of Level I to III studies.Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

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