Purpose
To explore whether platelet-rich plasma (PRP) injection can be a viable alternative
to corticosteroid (CS) injection for conservative treatment of rotator cuff disease.
Methods
This study was conducted in accordance with the Preferred Reporting Items for Systematic
Reviews and Meta-analyses (PRISMA) guidelines. PubMed, EMBASE, The Cochrane Library,
and Web of Science were searched from January 1, 1990, to March 20, 2022, for English-language
randomized controlled trials that compared PRP and CS injections for patients with
rotator cuff disease. Two evaluators independently screened the literature, extracted
data, and assessed the level of evidence and methodologic quality of the enrolled
studies. The meta-analysis was conducted using RevMan software (version 5.3.3).
Results
Thirteen nonsurgical randomized controlled trials with 725 patients were included.
Compared with CS, PRP provided statistically worse short-term (<2 months) changes
in American Shoulder and Elbow Surgeons (ASES) assessment scores, Simple Shoulder
Test scores, and Disabilities of the Arm, Shoulder and Hand questionnaire scores but
provided better medium-term (2-6 months) changes in Disabilities of the Arm, Shoulder
and Hand scores, as well as long-term (≥6 months) changes in Constant-Murley scores,
ASES scores, and Simple Shoulder Test scores. No statistically significant differences
regarding pain reduction were found between the 2 groups. PRP injections led to worse
short-term changes in forward flexion and internal rotation but better medium-term
changes in forward flexion and external rotation. PRP showed significantly lower rates
of post-injection failure (requests for subsequent injections or surgical intervention
prior to 12 months) than CS. No outcome reached the minimal clinically important difference.
After sensitivity analyses excluding studies with substantial clinical and/or methodologic
heterogeneity, PRP showed better medium-term changes in ASES scores and visual analog
scale scores and long-term changes in visual analog scale scores that reached the
minimal clinically important difference.
Conclusions
Without the drawbacks of CS injection, PRP injection is not worse than CS injection
in terms of pain relief and function recovery at any time point during follow-up.
PRP injection may reduce rates of subsequent injection or surgery, and it might provide
better improvements in pain and function in the medium to long term. PRP injection
can be a viable alternative to CS injection for conservative treatment of rotator
cuff disease.
Level of Evidence
Meta-analysis of Level I and II studies.
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Article info
Publication history
Published online: July 07, 2022
Accepted:
June 16,
2022
Received:
December 5,
2021
Footnotes
See commentary on page 422
L.P. and Y.X. contributed equally to this work.
The data sets used or analyzed in this study are available from the corresponding author on reasonable request.
The authors report the following potential conflicts of interest or sources of funding: This study was supported in part by grants from the National Natural Science Foundation of China (82072514; X.T.) and Science & Technology Department of Sichuan Province (2021YFS0238; X.T.). The authors report no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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