Purpose
To perform a randomized controlled trial comparing platelet-rich plasma (PRP) with
standard corticosteroid (CS) injection in providing pain relief and improved function
in patients with rotator cuff tendinopathy and partial-thickness rotator cuff tears
(PTRCTs).
Methods
This double-blind randomized controlled trial enrolled patients with ultrasound-proven
or magnetic resonance imaging–proven PTRCTs who received either an ultrasound-guided
PRP or CS injection. Patients completed patient-reported outcome assessments at baseline
and at 6 weeks, 3 months, and 12 months after injection. The primary outcome was improvement
in the visual analog scale (VAS) score for pain. Secondary outcomes included changes
in American Shoulder and Elbow Surgeons (ASES) and Western Ontario Rotator Cuff Index
(WORC) scores. Treatment failure was defined as subsequent injection, consent to undergo
surgery, or operative intervention.
Results
We followed up 99 patients (47 in the PRP group and 52 in the CS group) until 12 months
after injection. There were no differences in baseline patient demographic characteristics
including age, sex, or duration of symptoms. Despite randomization, patients in the
PRP group had worse baseline VAS (46.0 vs 34.7, P = .01), ASES (53.9 vs 61.8, P = .02), and WORC (42.2 vs 49.5, P = .03) scores. At 3 months after injection, the PRP group had superior improvement
in VAS (–13.6 vs 0.4, P = .03), ASES (13.0 vs 2.9, P = .02), and WORC (16.8 vs 5.8, P = .03) scores. There were no differences in patient-reported outcomes at 6 weeks
or 12 months. There was no difference in the rate of failure (P = .31) or conversion to surgery (P = .83) between groups.
Conclusions
Patients with PTRCTs or tendinopathy experienced clinical improvement in pain and
patient-reported outcome scores after both ultrasound-guided CS and PRP injections.
Patients who received PRP obtained superior improvement in pain and function at short-term
follow-up (3 months). There was no sustained benefit of PRP over CS at longer-term
follow-up (12 months).
Level of Evidence
Level I, randomized controlled trial.
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Article info
Publication history
Published online: October 27, 2020
Accepted:
October 16,
2020
Received:
March 28,
2020
See commentary on page 518Footnotes
The authors report the following potential conflicts of interest or sources of funding: I.K.Y.L receives fellowship support from Smith & Nephew and receives royalties from Smith & Nephew and Arthrex, outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
This study was the recipient of the Arthroscopy Association of North America 2019 Stephen S. Burkhart Shoulder Innovation Research Award.
Identification
Copyright
© 2020 by the Arthroscopy Association of North America
