Role of Platelet Rich Plasma Therapy on Rotator Cuff Disease

Abstract

Background: There is lack of evidence from randomized clinical trials that had assisted the efficacy of PRP in treating of rotator cuff diseases (RCD). Aim of the work: To study the effect of PRP injection on functional improvement on RCD, and to study the role of proinflammatory and angiogenesis-related cytokines as a pathogenic factor in RCD. Patients and methods:The study was conducted on 40 patients with RCD. All patients subjected to: clinical shoulder examination, clinical scoring including; (VAS and Los Angeles Shoulder score), cytokine assay of vascular endothelial growth factor (VEGF) and interleukin one beta (IL-1β), and diagnostic musculoskeletal ultrasound examination (MSU). All patients underwent two doses of ultrasound guided PRP injection with 4 weeks in-between. Reevaluation after 4 weeks from first injection was done using clinical scoring, cytokine assay and MSU. Third assessment was done 3 months from first injection using clinical scoring and MSU. Results: There was a statistically high significant decrease in pain, improvement of range of motion (ROM), power and functional state in all participants after 2 doses of PRP injection and rehabilitation program. In addition, there was a highly statistical significant decrease of cytokines serum levels after 4 weeks. There was a highly significant improvement regarding MSU grading. There was positive correlation between the serum levels of cytokines and VAS and negative correlation between the serum levels of cytokines and other clinical scores. There was positive correlation between the serum levels of VEGF and MSU grading. Conclusion:PRP therapy is an effective treatment for RCD and lead to functional improvement. There is a strong correlation between levels of cytokines (IL-1β and VEGF) and clinical scores before injection and 4 weeks following first injection. There is strong correlation between level of VEGF and ultrasound grading of RCD.