Time-Dependent Efficacy and Safety of Percutaneous Treatments for Lateral Epicondylitis: A Systematic Review and Network Meta-Analysis

Recent reviews on lateral epicondylitis management frequently focus on single modalities or isolated outcomes. This study systematically evaluates the time-dependent efficacy and safety of eight percutaneous treatments (placebo, corticosteroids, platelet-rich plasma [PRP], autologous blood [AB], hyaluronic acid, botulinum toxin [BT], dextrose prolotherapy [DPT], and dry needling [DN]) for lateral epicondylitis. Four databases (PubMed, Embase, the Cochrane Library, and Web of Science) were searched for randomized controlled trials. Outcomes (pain intensity, functional disability, grip strength) were evaluated across short- (<1 month), mid- (1-3 months), and long-term (>6 months) intervals. Data were synthesized via network meta-analysis using mean differences (MD) or standardized mean differences (SMD) and SUCRA probabilities. Forty-one trials (N=3,285) were included. Corticosteroids showed substantial efficacy for short-term pain relief (MD -1.62, 95% CI -2.52 to -0.72) but were associated with a long-term rebound effect. DPT demonstrated notable advantages for mid-term pain reduction (MD -1.73, 95% CI -2.85 to -0.60) and functional recovery. BT was associated with a potential negative trend in mid-term grip strength compared to placebo, whereas AB showed better outcomes than BT in head-to-head comparisons. For long-term outcomes, regenerative approaches like PRP, along with DN and BT, appeared to provide sustained pain relief. The therapeutic efficacy of percutaneous treatments appears to be time-dependent. Corticosteroids may be considered for rapid short-term relief, while DPT shows potential advantages for mid-term recovery. For long-term management, PRP and DN may offer sustained analgesia, potentially avoiding the grip strength deficits occasionally associated with BT.