Comparison of the Efficacy of Dextrose Prolotherapy in Lateral Elbow Tendinopathy: A Systematic Review and Meta-analysis of Randomized Controlled trials


  • Chernkhuan Stonsaovapak Chulalongkorn hospital
  • Natthiya Tantisiriwat Chulalongkorn hospital


dextrose prolotherapy, lateral epicondylitis, regenera-tive medicine, tennis elbow, treatment


Objectives: To compare the efficacy of dextrose prolotherapy (DPT) and alternative treatments for lateral elbow tendinopathy (LET) patients.

Study design: A systematic review and meta-analysis.

Setting: Not applicable.

Subjects: Patients in all stages of LET.

Methods: The authors searched databases of studies that compared the efficacy of DPT to alternative treatments for LET published in PubMed and Scopus from 1 January 2001 to 20 April 2021. The primary outcomes were the visual analog scale for pain (VAS) at rest and during movement. Secondary outcomes included pain-free grip strength, Quick Disabilities of the Arm, Shoulder and Hands (QuickDASH) scores, and Patient-Rated Tennis Elbow Evaluation (PRTEE) scores. The data, provided as means and standard deviations, were converted to standardized mean differences (SMD) with 95% confidence intervals (CI). The Review Manager 5.3 Software, Risk of Bias 2, and Grading of Recommendations, Assessment, Development and Evaluations (GRADE) were used for data analysis, risk of bias assessment, and quality assessment.

Results: Six randomized controlled trials (RCTs) which met the eligibility criteria were included. In each of those trials, the DPT group had significantly reduced VAS pain scores at rest and during movement at 12 weeks post-treatment compared to the other treatment groups. In terms of function improvement, the DPT group also had significantly greater improvement in QuickDASH scores than the other treatment groups at 12 weeks. However, these positive findings were based on methodologies which had a moderate to high risk of bias and were underpowered.

Conclusions: DPT requires additional high-quality RCTs to deter-mine the benefits to patients with LET. The main reason for the inconclusive results in this study was that most of the reviewed RCTs demonstrated a moderate to high risk of bias.

Keywords: dextrose prolotherapy, lateral epicondylitis, regenera-tive medicine, tennis elbow, treatment


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Systematic Review