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Synopsis: 8 ACE Reports (7 randomized controlled trials and 1 systematic review and meta-analysis, n=694) from the OrthoEvidence database assessing the effectiveness of corticosteroid injections in comparison to control injections (either saline or local anesthesia) for the treatment of lateral epicondylitis were included in this review.The purpose of this review was to determine the impact of corticosteroid injections on pain and physical function in comparison to these control treatments.As such, information and data on platelet-rich plasma (PRP) injection efficacy as a treatment was not included from reports.Statistical pooling of VAS pain scores and Quick DASH scores exhibited that corticosteroid injections provided significant pain relief, compared to control injections only in the short-term (6-12 weeks), while having no functional benefits over control injections at any time point within a 6 month period. Similar results were... Read More »
ACE Review
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Synopsis: 21 patients diagnosed with chronic recalcitrant plantar fasciitis were randomized to receive either dextrose prolotherapy (DP) or autologous platelet-rich plasma (PRP) injection therapy.The purpose was to evaluate the efficacies of these treatments and additionally, to assess whether one is more effective.Results at 28 weeks indicated that both treatments significantly improved total Foot Function Index scores versus baseline but no between-group differences were found. Nevertheless, PRP provided... Read More »
Author verified Level 2 RCT
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Synopsis: Six ACE Reports (5 randomized controlled trials and 1 systematic review/meta-analysis) were identified from the OrthoEvidence database which evaluated the efficacy of platelet-rich plasma in the treatment of knee osteoarthritis.All included studies were randomized controlled trials, and reported clinical and functional assessment at various time points between 1 and 6 months following treatment.Pooled analysis of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Total scores suggested a possible beneficial effect with PRP injection in comparison to saline and a lower effect versus hyaluronic acid.Beneficial effects were also noted for individual subscales of the WOMAC assessment (pain, stiffness, and physical function).However, pooling of OMERACT-OARSI responders and a review of the literature indicated that there was no significant difference between PRP and comparison groups in other functional outcome measures, such as the International Knee Documentation Committee (IKDC) assessment and Knee Injury and Osteoarthritis Outcome Score (KOOS).Furthermore, contrasting results were obtained between two studies reporting function on the Lequesne Index. The discrepancy in... Read More »
ACE Review
5%
Synopsis: Six ACE Reports were identified from the OrthoEvidence database which compared intra-articular injection(s) of hyaluronic acid to corticosteroid in the treatment of osteoarthritis of the knee.All of the included studies were randomized controlled trials which reported pain and/or functional outcomes within 6 months of intervention.Pooled analysis of pain on a visual analog scale indicated that pain relief was significantly better with hyaluronic acid injections at both 3 and 6 months follow-up; however, this finding was strongly influenced by two studies of lower methodological quality. No significant differences between hyaluronic acid and corticosteroid injections were observed in any functional outcome measurement.Due to incomplete or lack of reporting adverse events, an assessment of safety could not be performed along with this review. Furthermore, these findings... Read More »
ACE Review
5%
Synopsis: Seven studies were included in this meta-analysis which aimed to determine the effect of the application of platelet-rich products (PRP) in arthroscopic rotator cuff repair.Pooled analyses of functional outcome measurements indicated no beneficial effect of PRP at a minimum of 12 months postoperatively, and overall no decrease in retear rate. However, an analysis... Read More »
Level 1 Meta Analysis
5%
Synopsis: 50 patients with sacroiliac joint pain were randomized to receive injection treatments of either intra-articular prolotherapy (5% dextrose water) or intra-articular corticosteroid to evaluate the sustained pain relief effects of each treatment.The trial used the Numerical Rating System (NRS) and the Oswestry disability index (ODI) for pain and disability respectively. The study found... Read More »
Level 2 RCT
5%
Synopsis: 7 randomized controlled trials (RCTs) were included in this systematic review and meta-analysis comparing conservative treatment methods of intra-articular hyaluronic acid injections and corticosteroid injections.Pain scores were pooled at 2, 4, 8, 12, and 26 weeks post-injection.At early follow-up (2 weeks), treatment with corticosteroid injections resulted in lower pain when compared to treatment with hyaluronic acid injections.From 4-8 weeks, treatment displayed similar efficacy.At 12 weeks and 26 weeks, hyaluronic acid injections demonstrated significantly lower pain scores compared to corticosteroid injections. Read More »
Level 1 Meta Analysis
5%
Synopsis: 73 patients with rotator cuff tendinopathy were randomized to one of three study treatment groups: (1) hypertonic dextrose prolotherapy injection directly to affected entheses, (2) saline injection directly to affected entheses, or (3) saline injection superficial to affected entheses.The purpose of this study was to investigate the clinical benefits of dextrose prolotherapy when compared to control groups by observing improved patient-reported pain scores, patient satisfaction scores, and ultrasound grading of regenerative effect. Results demonstrated that... Read More »
Author verified Level 2 RCT
5%
Synopsis: 342 patients with chronic, nonspecific low back pain were randomized to one of three study arms for the purpose of evaluating improvement in back pain-related functional limitations, back pain, and back pain bothersomeness after 8 weeks of conservative therapy: (1) mindfulness-based stress reduction (MBSR), (2) cognitive behavioural therapy (CBT), and (3) usual care.The results demonstrated that both MBSR and CBT patients showed similar significant improvements over the usual care group for all outcomes throughout study duration (52-week post treatment initiation).No clinically significant differences between the MBSR and CBT therapy groups were observed at any time point. Read More »
Author verified Level 2 RCT
5%
Synopsis: 27 randomized controlled trials (RCT) were included in this bayesian network meta-analysis to provide a comprehensive comparison of injection therapies for lateral epicondylitis.A total of 13 therapies were identified from the literature.The results from this study indicated that for pain reduction, hyaluronic acid and prolotherapy injections were ranked one and two, respectively.However, the fact hyaluronic acid and prolotherapy were each only evaluated in one study highlights the need for additional research.While corticosteroid injections are the most frequently used injection therapy, this analysis indicates it provides suboptimal results, ranking 11th out of 13 treatments.The collection of data at 26 weeks may have led to corticosteroid injections to rank lower due to the transient benefit typically observed for this treatment. Read More »
Level 1 Meta Analysis