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

Purpose: 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. Patients and Methods: 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. Results: 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. Conclusion: 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.