Complications of Platelet-Rich Plasma Injections for Lateral Epicondylitis Occur at Comparable Rates to Those of Corticosteroid and Saline Injections: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Abstract

To investigate complications of platelet-rich plasma (PRP) injections for lateral epicondylitis. A systematic review of PubMed, Embase, Web of Science and Cochrane databases was conducted in accordance with the Preferred Reporting Items for Systematic Reviews protocol to identify all randomized control trials that documented complications following PRP injections for lateral epicondylitis. Studies were included if they compared PRP to another injectable and were excluded if they did not report complications. Summary statistics and number needed to harm were calculated. Meta-analyses were conducted using DerSimonian-Laird random-effects models, reported in odds ratios (OR). For variables with three or more studies, subgroup analyses of comparator injection and PRP preparation method were performed. Ten randomized control trials were identified that compared PRP to alternative therapies of corticosteroid, saline, hyaluronic acid, and autologous whole blood injections. There was a total of 615 patients, 298 of whom underwent PRP injections. Four studies reported zero complications. No severe complications were reported. Meta-analysis revealed no difference in complications between PRP and corticosteroid (P = .24, I² = 0%) or saline (P = .63, I² = 30%) injections. Leukocyte-rich-PRP had more complications than leukocyte-poor-PRP (OR = 1.97 [1.12-3.48], I² = 0%, P = .02). The number needed to harm for PRP injections was 19. The most common complication was pain at the injection site, with a rate of 13.09% (39/298) in the PRP group and 6.94% (22/317) in the comparison group (P = .011). Categorical variable analysis revealed there was a higher complication rate for PRP (44/298, 14.77%) than for the comparison (30/317, 9.46%) group (P = .043), but complication rates were comparable when excluding pain as a complication. Complications from PRP, corticosteroid, and saline injections for lateral epicondylitis were comparable without any serious adverse events. Pain was the most common complication reported in both PRP and comparison groups but was more common with PRP. In all studies, pain resolved within their respective study periods. Level II, meta-analysis of Level I and Level II randomized controlled trials.