The Comparative Effectiveness of Autologous Blood-derived Products Versus Steroid Injections in Plantar Fasciitis: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

ABSTRACT

OBJECTIVE: Plantar fasciitis is one of the most common musculoskeletal diseases, and nearly 90% of patients can be successfully treated by nonsurgical options. However, it is yet to be determined which nonsurgical treatment has the best efficacy. The present study investigated differences between autologous blood-derived products and corticosteroid injections in the treatment of plantar fasciitis. TYPE Systematic Review and Meta-analysis. LITERATURE SURVEY PubMed, EMBASE, CINAHL, and Web of Science were searched for relevant articles up to November 2019. There was no language restriction, and unpublished trials were excluded. This systematic review included only randomized controlled trials. METHODOLOGY: The primary outcomes were Visual Analog Scale and American Orthopedic Foot and Ankle Score (AOFAS). The follow-up times were divided into short term (3-6 weeks), intermediate term (3 months or 12 weeks), and long term (6 months or 24 weeks). The random-effects model was utilized, and weighted mean difference was calculated as the pool estimates. SYNTHESIS: Thirteen randomized controlled trials and 640 patients were included. No significant difference in Visual Analog Scale reduction was observed between autologous blood-derived product and corticosteroid injections in the short term (weighted mean difference [WMD] = -0.84; 95% confidence interval [CI], -1.71 to 0.03; P = .057), intermediate term (WMD = -0.24; 95% CI, -0.90 to 0.42; P = .475), and long term (WMD = 0.47; 95% CI, -0.72 to 1.65; P = .44). No significant difference in AOFAS was observed between autologous blood-derived products and corticosteroids in the short term (WMD = -0.65; 95% CI, -5.40 to 4.10; P = .79), intermediate term (WMD = 0.17; 95% CI, -8.07 to 8.41; P = .97), and long term (WMD = 1.16; 95% CI, -4.54 to 6.86; P = .69). CONCLUSIONS: This systematic review and meta-analysis of autologous blood-derived products versus corticosteroids for plantar fasciitis is the first that includes only randomized controlled trials. The meta-analysis found no significant difference between autologous blood-derived products and corticosteroids, as measured by Visual Analog Scale or AOFAS. These findings applied whether followed up in short, intermediate, or long term. These results differ from previous studies that showed superior efficacy of autologous blood-derived products compared with corticosteroids in the long term.