Abstract
Purpose
The purpose of this study was to explore whether PRP injection can be a viable alternative
to CS injection for conservative treatment of rotator cuff disease.
Methods
The 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 for English-written randomized controlled trials
(RCTs) which compared PRP and CS injections for patients with rotator cuff disease
from January 1, 1990, to March 20, 2022. Two evaluators independently screened the
literature, extracted data, and assessed the level of evidence and methodological
quality of the enrolled studies. The meta-analysis was conducted using RevMan 5.3.3
software.
Results
Thirteen non-surgical RCTs with 725 patients were included. Compared with CS, PRP
provided statistically worse short-term (＜2 months) changes (Δ) of the American Shoulder
and Elbow Surgeons (ASES) assessment, Δ the Simple Shoulder Test (SST), Δ the Disability
of Arm, Shoulder and Hand (DASH) questionnaires but better medium-term (2 to 6 months)
Δ DASH, long-term (≥ 6 months) Δ Constant-Murley Score (CMS), Δ ASES and Δ SST. No
statistical differences regarding pain reduction were found between the two groups.
PRP injections led to worse short-term Δ forward flexion, Δ internal rotation but
better medium-term Δ forward flexion and Δ external rotation. PRP had significantly
lower rates of postinjection failure (requests for a subsequent injection or surgical
intervention prior to 12 months) than CS. No outcome reached the minimal clinically
important difference (MCID). After sensitivity analyses by excluding studies with
substantial clinical and/or methodological heterogeneity, PRP showed better medium-term
Δ ASES, Δ VAS, and long-term Δ VAS which reached the MCID.
Conclusions
Without the drawbacks of CS injection, PRP injection is not worse than CS injection
in pain relief and function recovery at any time point of the follow-up. PRP injection
may reduce rates of subsequent injection or surgery, and might provide better improvement
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
Systematic review of Level I and II studies.
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Reference
- Evaluation and treatment of shoulder pain.Med Clin North Am. 2014; 98: 487-504
- Diagnosis and relation to general health of shoulder disorders presenting to primary care.Rheumatology (Oxford). 2005; 44: 800-805
- Degree of tendon degeneration and stage of rotator cuff disease.Knee Surg Sports Traumatol Arthrosc. 2017; 25: 2100-2108
- A systematic review and pooled analysis of the prevalence of rotator cuff disease with increasing age.J Shoulder Elbow Surg. 2014; 23: 1913-1921
- Surgical Versus Nonsurgical Management of Rotator Cuff Tears: A Matched-Pair Analysis.J Bone Joint Surg Am. 2019; 101: 1775-1782
- Physical therapy versus natural history in outcomes of rotator cuff tears: the Rotator Cuff Outcomes Workgroup (ROW) cohort study.J Shoulder Elbow Surg. 2019; 28: 833-838
- Shoulder Rotator Cuff Disorders: A Systematic Review of Clinical Practice Guidelines and Semantic Analyses of Recommendations.Arch Phys Med Rehabil. 2020; 101: 1233-1242
- Corticosteroid Injections Give Small and Transient Pain Relief in Rotator Cuff Tendinosis: A Meta-analysis.Clin Orthop Relat Res. 2017; 475: 232-243
- Detrimental Effect of Repeated and Single Subacromial Corticosteroid Injections on the Intact and Injured Rotator Cuff: A Biomechanical and Imaging Study in Rats.Am J Sports Med. 2016; 44: 177-182
- Comparative Effectiveness of Injection Therapies in Rotator Cuff Tendinopathy: A Systematic Review, Pairwise and Network Meta-analysis of Randomized Controlled Trials.Arch Phys Med Rehabil. 2019; 100 (e315): 336-349
- The Timing of Corticosteroid Injections After Arthroscopic Shoulder Procedures Affects Postoperative Infection Risk.Am J Sports Med. 2019; 47: 915-921
- The Timing of Injections Prior to Arthroscopic Rotator Cuff Repair Impacts the Risk of Surgical Site Infection.J Bone Joint Surg Am. 2019; 101: 682-687
- Are corticosteroid injections more beneficial than anaesthetic injections alone in the management of rotator cuff-related shoulder pain? A systematic review.Br J Sports Med. 2018; 52: 497-504
- Effects of Platelet-Rich Plasma With Concomitant Use of a Corticosteroid on Tenocytes From Degenerative Rotator Cuff Tears in Interleukin 1β-Induced Tendinopathic Conditions.Am J Sports Med. 2017; 45: 1141-1150
- Platelet-Rich Plasma Activates Proinflammatory Signaling Pathways and Induces Oxidative Stress in Tendon Fibroblasts.Am J Sports Med. 2016; 44: 1931-1940
- Platelet-rich plasma: a narrative review.EFORT Open Rev. 2021; 6: 225-235
- Autologous blood and platelet-rich plasma injection therapy for lateral elbow pain.Cochrane Database Syst Rev. 2021; 9: Cd010951
- To Improve Pain and Function, Platelet-Rich Plasma Injections May Be an Alternative to Surgery for Treating Lateral Epicondylitis: A Systematic Review.Arthroscopy. 2021; 37: 3360-3367
- Platelet-rich plasma in tendon-related disorders: results and indications.Knee Surg Sports Traumatol Arthrosc. 2018; 26: 1984-1999
- Platelet-Rich Plasma Injections as a Treatment for Refractory Patellar Tendinosis: A Meta-Analysis of Randomised Trials.Knee Surg Relat Res. 2017; 29: 165-171
- The Efficacy of Platelet-Rich Plasma on Tendon and Ligament Healing: A Systematic Review and Meta-analysis With Bias Assessment.Am J Sports Med. 2018; 46: 2020-2032
- The Efficacy of Injections for Partial Rotator Cuff Tears: A Systematic Review.J Clin Med. 2020; : 10
- Platelet-rich plasma injection vs corticosteroid injection for conservative treatment of rotator cuff lesions: A protocol for systematic review and meta-analysis.Medicine (Baltimore). 2021; 100e24680
- The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration.Bmj. 2009; 339: b2700
- Measures of adult shoulder function: Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH) and its short version (QuickDASH), Shoulder Pain and Disability Index (SPADI), American Shoulder and Elbow Surgeons (ASES) Society standardized shoulder assessment form, Constant (Murley) Score (CS), Simple Shoulder Test (SST), Oxford Shoulder Score (OSS), Shoulder Disability Questionnaire (SDQ), and Western Ontario Shoulder Instability Index (WOSI).Arthritis Care Res (Hoboken). 2011; 63: S174-188
- Scoring systems for the functional assessment of the shoulder.Arthroscopy. 2003; 19: 1109-1120
- Assessing pain intensity with the visual analog scale: a plea for uniformity.J Clin Pharmacol. 2014; 54: 241-244
- Platelet-Rich Plasma Versus Corticosteroid Injections in the Management of Elbow Epicondylitis and Plantar Fasciitis: An Updated Systematic Review and Meta-analysis.Am J Sports Med. 2020; 48: 2572-2585
- Minimum Clinically Important Difference: Current Trends in the Orthopaedic Literature, Part I: Upper Extremity: A Systematic Review.JBJS Rev. 2018; 6: e1
- Quantifying the minimal and substantial clinical benefit of the Constant-Murley score and the Disabilities of the Arm, Shoulder and Hand score in patients with calcific tendinitis of the rotator cuff.JSES Int. 2020; 4: 606-611
- Minimal clinically important differences in ASES and simple shoulder test scores after nonoperative treatment of rotator cuff disease.J Bone Joint Surg Am. 2010; 92: 296-303
- Minimal Clinically Important Difference of Oxford, Constant, and UCLA shoulder score for arthroscopic rotator cuff repair.J Orthop. 2020; 19: 21-27
- Establishing minimal clinically important difference for the UCLA and ASES scores after rotator cuff repair.Orthop Traumatol Surg Res. 2021; (102894)
- Minimal clinically important differences (MCID) and patient acceptable symptomatic state (PASS) for visual analog scales (VAS) measuring pain in patients treated for rotator cuff disease.J Shoulder Elbow Surg. 2009; 18: 927-932
- The Cochrane Collaboration's tool for assessing risk of bias in randomised trials.Bmj. 2011; 343: d5928
- Measures of interrater agreement.J Thorac Oncol. 2011; 6: 6-7
- Comparison of Functional Outcome Between Intra-Articular Injection of Corticosteroid Versus Platelet-Rich Plasma in Frozen Shoulder: A Randomized Controlled Trial.Cureus. 2021; 13e20560
- Single Intra-articular Platelet-Rich Plasma Versus Corticosteroid Injections in the Treatment of Adhesive Capsulitis of the Shoulder: A Cohort Study.Am J Phys Med Rehabil. 2019; 98: 549-557
- Ultrasound-guided Platelet-rich Plasma Application Versus Corticosteroid Injections for the Treatment of Greater Trochanteric Pain Syndrome: A Prospective Controlled Randomized Comparative Clinical Study.Cureus. 2020; 12e6583
- Platelet-rich plasma versus corticosteroid injections for rotator cuff tendinopathy: a comparative study with up to 18-month follow-up.Clin Shoulder Elb. 2022; 25: 28-35
- Platelet-rich plasma versus steroid injection for subacromial impingement syndrome.J Orthop Surg (Hong Kong). 2016; 24: 62-66
- Subacromial injection of autologous platelet-rich plasma versus corticosteroid for the treatment of symptomatic partial rotator cuff tears.Eur J Orthop Surg Traumatol. 2016; 26: 837-842
- The effect of subacromial injections of autologous conditioned plasma versus cortisone for the treatment of symptomatic partial rotator cuff tears.Knee Surg Sports Traumatol Arthrosc. 2016; 24: 3787-3792
- Platelet-Rich Plasma and Corticosteroid in the Treatment of Rotator Cuff Impingement Syndrome: Randomized Clinical Trial.Rev Bras Ortop (Sao Paulo). 2019; 54: 636-643
- Ultrasound-guided injection of platelet rich plasma versus corticosteroid for treatment of rotator cuff tendinopathy: Effect on shoulder pain, disability, range of motion and ultrasonographic findings.Egyptian Rheumatologist. 2019; 41: 157-161
- Comparison of the Effectiveness of Platelet-Rich Plasma, Corticosteroid, and Physical Therapy in Subacromial Impingement Syndrome.Arch Rheumatol. 2019; 34: 308-316
- Allogeneic Platelet-Rich Plasma Versus Corticosteroid Injection for the Treatment of Rotator Cuff Disease: A Randomized Controlled Trial.J Bone Joint Surg Am. 2020; 102: 2129-2137
- Comparison of ultrasound-guided platelet-rich plasma, prolotherapy, and corticosteroid injections in rotator cuff lesions.J Back Musculoskelet Rehabil. 2020; 33: 387-396
- Corticosteroids or platelet-rich plasma injections for rotator cuff tendinopathy: a randomized clinical trial study.J Orthop Surg Res. 2021; 16: 333
- Platelet-Rich Plasma in Patients With Partial-Thickness Rotator Cuff Tears or Tendinopathy Leads to Significantly Improved Short-Term Pain Relief and Function Compared With Corticosteroid Injection: A Double-Blind Randomized Controlled Trial.Arthroscopy. 2021; 37: 510-517
- Efficacy of Adjuvant Application of Platelet-Rich Plasma After Needle Aspiration of Calcific Deposits for the Treatment of Rotator Cuff Calcific Tendinitis: A Double-Blinded, Randomized Controlled Trial With 2-Year Follow-up.Am J Sports Med. 2021; 49: 873-882
- What is better for rotator cuff tendinopathy: dextrose prolotherapy, platelet-rich plasma, or corticosteroid injections? A randomized controlled study.Egyptian Rheumatology and Rehabilitation. 2020; 47: 40
- Comparison of a Platelet-Rich Plasma Injection and a Conventional Steroid Injection for Pain Relief and Functional Improvement of Partial Supraspinatus Tears.Orthop J Sports Med. 2021; 923259671211024937
- Nonoperative Treatment of Rotator Cuff Disease With Platelet-Rich Plasma: A Systematic Review of Randomized Controlled Trials.Arthroscopy. 2019; 35: 1584-1591
- Management of Rotator Cuff Injuries.J Am Acad Orthop Surg. 2020; 28: e193-e201
- Selectively activated PRP exerts differential effects on tendon stem/progenitor cells and tendon healing.J Tissue Eng. 2019; 102041731418820034
- Platelet biology in regenerative medicine of skeletal muscle.Acta Physiol (Oxf). 2018; 223e13071
- Stem Cells and Platelet-Rich Plasma Enhance the Healing Process of Tendinitis in Mice.Stem Cells Int. 2019; 20191497898
- Platelet-Rich Plasma Injection With Arthroscopic Acromioplasty for Chronic Rotator Cuff Tendinopathy: A Randomized Controlled Trial.Am J Sports Med. 2015; 43: 2891-2897
- Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials.Lancet. 2010; 376: 1751-1767
- Subacromial corticosteroid injections transiently decrease suture anchor pullout strength: biomechanical studies in rats.J Shoulder Elbow Surg. 2017; 26: 1789-1793
- Effect of corticosteroids on the biomechanical strength of rat rotator cuff tendon.J Bone Joint Surg Am. 2009; 91: 1172-1180
- Increasing Numbers of Shoulder Corticosteroid Injections Within a Year Preoperatively May Be Associated With a Higher Rate of Subsequent Revision Rotator Cuff Surgery.Arthroscopy. 2019; 35: 45-50
- Injections Prior to Rotator Cuff Repair Are Associated With Increased Rotator Cuff Revision Rates.Arthroscopy. 2019; 35: 717-724
- Platelet-Rich Plasma: New Performance Understandings and Therapeutic Considerations in 2020.Int J Mol Sci. 2020; : 21
- High statistical heterogeneity is more frequent in meta-analysis of continuous than binary outcomes.J Clin Epidemiol. 2016; 70: 129-135
- Predicting the extent of heterogeneity in meta-analysis, using empirical data from the Cochrane Database of Systematic Reviews.Int J Epidemiol. 2012; 41: 818-827
Article Info
Publication History
Accepted:
June 16,
2022
Received in revised form:
June 12,
2022
Received:
December 5,
2021
Publication stage
In Press Journal Pre-ProofFootnotes
Consent to Publish: Not applicable.
Funding:
This study was supported in part by grants from National Natural Science Foundation of China (82072514; Xin Tang) and Science & Technology Department of Sichuan Province (2021YFS0238; Xin Tang).
Competing Interests:
The authors declare that they have no competing interests.
Availability of data and materials:
The datasets used or analyzed during the current study are available from the corresponding author on reasonable request.
Identification
Copyright
© 2022 by the Arthroscopy Association of North America
