Platelet-rich plasma and corticosteroid injection for tendinopathy: a systematic review and meta-analysis

In this systematic review and meta-analysis, we evaluated and compared the efficacy and safety of platelet-rich plasma injection into corticosteroid injection in the treatment of tendinopathy.

We searched PUBMED, EMBASE, Cochrane Library, SCOPUS, and Web of Science to identify randomized controlled trials on the PRP injection versus CS injection in treatment of tendinopathy.The meta-analysis was performed using the Revman 5.4 software.

We found 27 RCT studies with a total of 1779 patients enrolled. 8 rotator cuff injuries, 7 humeral external epicondylitis, 10 plantar fasciitis, and 2 tenosynovitis. The results of the meta-analysis showed that there were no significant group differences in the results of patients with rotator cuff injury comparing the pain visual analog scale score and functional measures at 1 month after receiving injection treatment. After three months of receiving PRP treatment, the VAS scores showed greater improvement compared to the CS group(OR = -1.64,95%CI [-2.97,-0.31],P = 0.02), while there was no statistically significant difference in shoulder joint function between the two groups at the 3-6 month post-treatment mark. Patients with plantar fasciitis showed no significant differences in VAS and AOFAS scores after receiving PRP or CS injections at 1 and 3 months. However, at the 6-month mark, the PRP group demonstrated significantly better VAS and AOFAS scores compared to the CS group(OR = -1.41,95%CI [-1.88,-0.44],P < 0.00001; OR = 7.19,95%CI [2.41,11.91],P = 0.003). 1 month after CS injection in patients with tenosynovitis, the VAS score was lower than that of the PRP group; patients with elbow epicondylitis had better improved upper limb function rating scale scores 1 month after CS injection compared to the PRP group. In patients with tenosynovitis, the VAS scores were superior to the CS group six months after PRP treatment(OR = -0.72,95%CI [-1.04,-0.40],P < 0.00001); similarly, patients with lateral epicondylitis exhibited better VAS, DASH scores than the CS group three and twelve months post-PRP treatment(OR = -9.76,95%CI [-10.89,-8.63],P = 0.0002; OR = -0.97,95%CI [-1.87,-0.06],P < 0.0001; OR = -18.03,95%CI [-31.61,-4.46],P = 0.009).

PRP can effectively improve pain and functional impairment in patients with tendinopathy, and its mid-term efficacy is superior to that of corticosteroids. However, the long-term efficacy remains to be further clinically verified.