Comparative Effectiveness of Injection Therapies in Rotator Cuff Tendinopathy: A Systematic Review, Pairwise and Network Meta-analysis of Randomized Controlled Trials

Effectiveness of Dextrose Prolotherapy for Rotator Cuff Tendinopathy: A Systematic Review

“…One large difference in methodology is that the majority of those enrolled in one-time single-site injections were compared to active interventions of enthesis saline, which has demonstrated some efficacy in the study of Bertrand et al, and subacromial corticosteroid injection, which has previously demonstrated efficacy in rotator cuff tendinopathy. 11,[24][25][26] Another methodologic difference is that patients included in one-time single-site injection studies tended to have milder baseline pain with lower pain intensity scores and improved baseline function with low SPADI scores and more active range of motion. Despite these methodologic differences, repeat multisite dextrose prolotherapy protocols demonstrated larger absolute improvements in VAS, SPADI, and range of motion.…”

“…Although both groups improved similarly, previous studies of corticosteroid demonstrate a short-term benefit, however, significant disease recurrence by 1-year follow-up. 11,25,27,40 Due to the significant variation between the one-time single-site injection and repeat multisite injection protocols utilized, it is unknown whether patients receiving dextrose prolotherapy would continue to improve or maintain their improvements at 1 year as seen in Seven et al and Bertrand et al However, there is potential, based on the proposed mechanism of dextrose and results of repeat multisite injection protocols that patients may continue to improve or merely maintain their improvements at a 1-year follow-up, whereas patients with corticosteroid will have significant disease recurrence. 11,25,27,40 Recently there has been concern regarding subacromial corticosteroid injection for rotator cuff tendinopathies and its effects on tendon integrity, [41][42][43][44] longterm disease recurrence and progression, [41][42][43][44] and effect on future surgical intervention.…”

“…11,25,27,40 Due to the significant variation between the one-time single-site injection and repeat multisite injection protocols utilized, it is unknown whether patients receiving dextrose prolotherapy would continue to improve or maintain their improvements at 1 year as seen in Seven et al and Bertrand et al However, there is potential, based on the proposed mechanism of dextrose and results of repeat multisite injection protocols that patients may continue to improve or merely maintain their improvements at a 1-year follow-up, whereas patients with corticosteroid will have significant disease recurrence. 11,25,27,40 Recently there has been concern regarding subacromial corticosteroid injection for rotator cuff tendinopathies and its effects on tendon integrity, [41][42][43][44] longterm disease recurrence and progression, [41][42][43][44] and effect on future surgical intervention. 5,6,45 Corticosteroid is thought to cause cellular apoptosis and alteration in collagen synthesis, which ultimately weakens and can rupture tendons, 41,45 reduce immunologic response, 41,45 and reduce the success of future surgical repairs by delaying or inhibiting healing.…”

“…[7][8][9][10] Prolotherapy, through the injection of hyperosmolar dextrose solution, was first used in the 1950s to treat ligamentous laxity and related musculoskeletal and arthritic conditions due to its ability to stimulate healing and fibrosis. 11,12 Within the last 10 years, there has been an emergence of evidence for prolotherapy for rotator cuff tendinopathy using various injection protocols and techniques to strengthen rotator cuff tendinous structures, repair tendinous defects, or eliminate pain stimuli. [12][13][14] Initial reports described a landmark-based technique targeting all tendon insertion sites surrounding the shoulder girdle and repeating weekly for several weeks.…”

Platelet‐Rich Plasma Vs Autologous Blood Vs Corticosteroid Injections in the Treatment of Lateral Epicondylitis: A Systematic Review, Pairwise and Network Meta‐Analysis of Randomized Controlled Trials

“…Their observation periods ranged from 6 weeks to more than 1 year . Beyond easing pain, clinical evidence of PRP potency in functional improvement was found in treating rotator cuff and refractory Achilles tendinopathies, with follow‐up durations of 6 months and more than 4 years, respectively . The potential biochemical mechanism underlying the temporary pain relief might involve the regulation of inflammation.…”