Platelet-rich plasma versus autologous blood versus steroid injection in XXXX : systematic review and network meta-analysis.

@entity1 @entity2633 @entity158
BACKGROUND: Clinical outcomes between the use of platelet-rich plasma (PRP), autologous blood (AB) and corticosteroid (CS) injection in @entity2633 are still controversial. MATERIALS AND METHODS: A systematic review and network meta-analysis of randomized controlled trials was conducted with the aim of comparing relevant clinical outcomes between the use of PRP, AB and CS injection. Medline and Scopus databases were searched from inception to January 2015. A network meta-analysis was performed by applying weight regression for continuous outcomes and a mixed-effect Poisson regression for dichotomous outcomes. RESULTS: Ten of 374 identified studies were eligible. When compared to CS, AB injection showed significantly improved effects with unstandardized mean differences (UMD) in @entity158 visual analog scale (VAS), Disabilities of Arm Shoulder and Hand (DASH), @entity1 -Related @entity2633 (PRTEE) score and pressure @entity158 threshold (PPT) of -2.5 (95  % confidence interval, -3.5, -1.5), -25.5 (-33.8, -17.2), -5.3 (-9.1, -1.6) and 9.9 (5.6, 14.2), respectively. PRP injections also showed significantly improved VAS and DASH scores when compared with CS. PRP showed significantly better VAS with UMD when compared to AB injection. AB injection has a higher risk of adverse effects, with a relative risk of 1.78 (1.00, 3.17), when compared to CS. The network meta-analysis suggested no statistically significant difference in multiple active treatment comparisons of VAS, DASH and PRTEE when comparing PRP and AB injections. However, AB injection had improved DASH score and PPT when compared with PRP injection. In terms of adverse effects, AB injection had a higher risk than PRP injection. CONCLUSIONS: This network meta-analysis provided additional information that PRP injection can improve @entity158 and lower the risk of complications, whereas AB injection can improve @entity158 , disabilities scores and pressure @entity158 threshold but has a higher risk of complications. LEVEL OF EVIDENCE: Level I evidence.
