Platelet-Rich Plasma Does Not Improve Pain or Function in Patients With Lateral Epicondylitis as Compared With Placebo: A Meta-analysis of Randomized Clinical Trials

Background: Lateral epicondylitis, commonly known as tennis elbow, is a prevalent musculoskeletal disorder characterized by pain and functional impairment. Platelet-rich plasma (PRP) has been proposed as a regenerative treatment, but its efficacy remains controversial. Purpose: To assess the efficacy and safety of PRP in improving pain and function in patients with lateral epicondylitis as compared with placebo through a systematic review and meta-analysis of randomized clinical trials (RCTs). Study Design: Systematic review and meta-analysis of RCTs; Level of evidence: 1. Methods: A comprehensive literature search was conducted in PubMed, Scopus, Embase, and Cochrane CENTRAL for RCTs comparing PRP with placebo in lateral epicondylitis. Primary outcomes included pain relief and functional improvement assessed at multiple time points (4, 8-12, and 24-26 weeks). Secondary outcomes included adverse events and grip strength. Statistical analyses used standardized mean difference (SMD), mean difference (MD), and risk ratios with 95% confidence intervals (95% CIs). Results: Six RCTs with 355 patients were included. PRP did not provide significant pain relief at 4 weeks (SMD, 0.08; 95% CI, –0.17 to 0.34; P = .526), 8 to 12 weeks (SMD, –0.36; 95% CI, –0.99 to 0.27; P = .263), or 24 to 26 weeks (MD, –1.58; 95% CI, –4.74 to 1.58; P = .328). Functional improvement was also not significantly different at 4 weeks (SMD, 0.09; 95% CI, –0.18 to 0.37; P = .518), 12 weeks (SMD, –0.09; 95% CI, –0.39 to 0.21; P = .565), or 24 to 26 weeks (SMD, 0.13; 95% CI, –0.18 to 0.43; P = .413). No significant difference was found in adverse events (risk ratio, 1.66; 95% CI, 0.65-4.19; P = .287). Conclusion: PRP does not provide significant pain relief or functional improvement in patients with lateral epicondylitis in the current study of available RCTs as compared with placebo at all evaluated time points. These findings do not support PRP as a recommended treatment for this condition.