{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T10:17:13Z","timestamp":1788171433561,"version":"build-2803163510"},"reference-count":51,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Lateral elbow tendinopathy (LET) causes chronic pain and functional limitation, and the evidence base is confounded by the \u201clumping\u201d of biologically and physically distinct interventions. We conducted a systematic review and network meta-analysis (NMA) distinguishing focused (fESWT) from radial (rESWT) extracorporeal shockwave therapy (ESWT) and leukocyte-rich (LrPRP) from leukocyte-poor (LpPRP) platelet-rich plasma (PRP) to establish a precise hierarchy of treatment efficacy. Methods: We searched PubMed, EMBASE, Cochrane, Scopus, and Web of Science from inception to 8 December 2025, with the search updated on 12 August 2026. Twenty-three randomized controlled trials (1484 participants) evaluating fESWT, rESWT, LrPRP and LpPRP were included. Standardized mean differences (SMDs) were calculated using a random-effects model, and treatments were ranked by the surface under the cumulative ranking curve (SUCRA). Results: fESWT ranked highest for grip strength overall (SUCRA: 82.6) and in the short term (\u22643 months; 78.4). For upper-limb disability (Disabilities of the Arm, Shoulder and Hand), rESWT ranked highest overall (92.9) and in the long term (\u22656 months; 94.0), while fESWT ranked lowest (19.9). rESWT was also most effective for pain at rest (Visual Analogue Scale; 86.6) and fESWT for disease-specific function (Patient-Rated Tennis Elbow Evaluation; 81.9), both significantly superior to placebo. The LrPRP advantage did not persist when trials at high risk of bias were excluded. Conclusions: Clinical outcomes in LET are influenced by the specific subtypes of ESWT and PRP. rESWT was most effective for pain at rest and long-term upper-limb function, whereas fESWT was superior for short-term grip strength and disease-specific function. The apparent benefit of LrPRP was less robust and should be regarded as preliminary, and treatment selection should be tailored to a patient\u2019s recovery priorities.<\/jats:p>","DOI":"10.3390\/jcm15176679","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T09:21:19Z","timestamp":1788168079000},"page":"6679","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative Effectiveness of Focused Versus Radial Extracorporeal Shockwave Therapy and Leukocyte-Poor Versus Leukocyte-Rich Platelet-Rich Plasma for Lateral Epicondylitis: A Network Meta-Analysis"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5509-8971","authenticated-orcid":false,"given":"Jun Min","family":"Cha","sequence":"first","affiliation":[{"name":"Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0365-2923","authenticated-orcid":false,"given":"Seo Yeon","family":"Yoon","sequence":"additional","affiliation":[{"name":"Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5234-2454","authenticated-orcid":false,"given":"Yong Wook","family":"Kim","sequence":"additional","affiliation":[{"name":"Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4272-7489","authenticated-orcid":false,"given":"Jong Mi","family":"Park","sequence":"additional","affiliation":[{"name":"Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6241-7392","authenticated-orcid":false,"given":"Sang Chul","family":"Lee","sequence":"additional","affiliation":[{"name":"Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"259","DOI":"10.2106\/00004623-199902000-00014","article-title":"Tendinosis of the elbow (tennis elbow). 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