Laser therapy versus extracorporeal shock wave therapy for the treatment of lateral epicondylitis: a systematic review and meta-analysis of randomized controlled trials.

To compare the clinical efficacy of laser therapy (LT) versus extracorporeal shock wave therapy (ESWT) in the management of lateral epicondylitis. PubMed, Scopus, Web of Science, CENTRAL, and Google Scholar were systematically searched for eligible randomized controlled trials (RCTs). Our specific endpoints included pain severity, hand grip strength, and patient-reported outcomes assessed using various assessment tools. We conducted subgroup analyses based on the type of LT used, specifically high-intensity laser therapy (HILT) or low-intensity laser therapy (LILT) versus ESWT. Data were presented as mean differences (MD) or standardized mean differences (SMD) with 95% confidence interval (CI). Seven RCTs involving 323 patients were analyzed. The meta-analysis showed no significant differences between the LT and ESWT groups in pain severity at rest (n = 5 RCTs, SMD = -0.30, 95% CI [-0.73, 0.13], p = 0.17), pain severity during movement (n = 7 RCTs, SMD = -0.23, 95% CI [-0.81, 0.36], p = 0.45), hand grip strength (n = 5 RCTs, MD = -0.73, 95% CI [-3.85, 2.39], p = 0.65), and patient-reported endpoints (n = 6 RCTs, SMD = -0.07, 95% CI [-0.50, 0.36], p = 0.75). Leave-one-out sensitivity analysis confirmed the robustness of these results, consistently demonstrating stability across all scenarios. Subgroup analysis showed no significant differences between HILT and ESWT or LILT and ESWT, except for hand grip strength, where ESWT was superior to LILT in lateral epicondylitis patients. This systematic review and meta-analysis demonstrates that LT has comparable efficacy to ESWT for the management of lateral epicondylitis. However, to consolidate these findings, further large-scale RCTs with robust methodological designs are needed.