Injection therapies for lateral epicondylalgia: a systematic review and Bayesian network meta-analysis.

Area of Science:

• Orthopedics
• Sports Medicine
• Regenerative Medicine

Background:

• Lateral epicondylalgia (tennis elbow) has numerous injection therapies.
• No comprehensive Bayesian meta-analysis comparing these treatments previously existed.

Purpose of the Study:

• To conduct a comprehensive Bayesian network meta-analysis comparing various injection therapies for lateral epicondylalgia.
• To rank the efficacy of different injection treatments and identify optimal therapeutic options.

Main Methods:

• Searched MEDLINE, EMBASE, and CENTRAL databases for relevant studies.
• Performed pairwise and Bayesian network meta-analysis using pain scores as the primary outcome.
• Conducted sensitivity, inconsistency, and metaregression analyses to assess study quality and treatment effect modifiers.

Main Results:

• All injection treatments demonstrated a trend towards improved outcomes compared to placebo.
• The peppering technique did not provide additional benefits when combined with other treatments.
• Sensitivity analysis excluding low-quality studies and metaregression on sample size did not alter the main findings.

Conclusions:

• Botulinum toxin, platelet-rich plasma, and autologous blood injections are viable treatment candidates for lateral epicondylalgia.
• Corticosteroid injections are not recommended; hyaluronate and prolotherapy show potential but require further research.
• The peppering technique is ineffective for injection therapy in lateral epicondylalgia.