Treatment of Rotator Cuff Tears with platelet rich plasma: a prospective study with 2 year follow‐up

Abstract

Background Surgical treatment of full-thickness rotator cuff (RC) tears is associated with generally good results. There is no consensus regarding treatment of partial thickness tears that fail conservative treatment. The purpose of this study was to look at the efficacy and confirm the safety of dual injection PRP into the shoulder of patients with rotator cuff pathology who have failed conservative treatment with followup to two years. Methods Seventy-one shoulders with MRI confirmed, rotator cuff pathology who failed conservative treatment, had dual PRP injection into the rotator cuff. Global improvement, Quick DASH and VAS scores were collected at 6, 12, and 24 months after treatment and comparison of means was used to analyze changes. Results No adverse events were seen in any patient. Based on global rating scores positive results were seen in 77.9 % of patients at 6 months, 71.6 % at 1 year, and 68.8 % of patients at 2 years. Mean VAS scores improved from 50.2 [CI 44.4–56.0] pre-injection to 26.2 [CI 19.5–32.9] at 6 months, 22.4[CI 16.1–28.7] at 1 year and 18.2 [CI 12.3–24.1] at 2 years (p < 0.0001 for all). The mean Q- DASH scores (0-100, 100 worse) improved from 39.2 [CI 34.3–44.1] for all patients before treatment to 20.7[CI 15.0-26.4] at 6 months, 18.0[CI 12.9–23.1] at 1 year, and 13.8 [CI 8.4–18.8] at 2 years (p < 0.0001 for all). No patient with partial tear had clinical evidence of progression to full thickness tear. When separated into subgroups based on rotator cuff status, all subgroups showed improvement. Patients in the > 50 % partial tear group had the best overall improvement based on Global Rating scores while those in the tendinitis group had the poorest outcomes. Conclusions PRP injection is a safe and effective treatment for RC cuff injury in patients who have failed conservative treatment of activity modification and physical therapy without deterioration of results two years after treatment. Better results are obtained with greater structural tendon damage than in shoulders with inflammation without structural damage. Trial registration This is not a clinical trial.

Collagen and platelet-rich plasma in partial-thickness rotator cuff injuries. Friends or only indifferent neighbours? Randomised controlled trial

“…Due to the risk of surgery, reduced strength of RC tendons, and a significant risk of injury recurrence, conservative options are the first choice, especially in older adults [11,12]. These conservative procedures comprise physical therapy and pharmacotherapy with steroid injections for anti-inflammatory effects, platelet-rich plasma (PRP), collagen injections, and autologous conditioned serum (ACS) for regenerative effects, as well as rehabilitation management [13][14][15].…”

Conservative Management of Partial Thickness Rotator Cuff Tears: A Systematic Review

“…Regarding the Level of Evidence, 5 studies were level I RCTs 30,31,34,37,38 ; 5 level III PCC studies 7,8,32,33,42 ; and 1 level IV prospective case-series study 36 …”

The role of platelet-rich plasma in shoulder pathologies: a critical review of the literature

“…Another meta-analysis by Wang et al assessed the safety of PRP in arthroscopic full-thickness rotator cuff repair. They found that PRP was safe and effectively improved the short-term outcomes following arthroscopic repair of full-thickness rotator cuff tears (72). Another study by Prodromos et al looking at the efficacy and safety of L-PRP in rotator cuff tears found that dual injections of L-PRP into the shoulder was safe and effective in patients that failed conservative treatment (73).…”

“…They found that PRP was safe and effectively improved the short-term outcomes following arthroscopic repair of full-thickness rotator cuff tears ( 72 ). Another study by Prodromos et al looking at the efficacy and safety of L-PRP in rotator cuff tears found that dual injections of L-PRP into the shoulder was safe and effective in patients that failed conservative treatment ( 73 ). However, Schwitzguebel et al , in their RCT, found that P-PRP was associated with higher incidence of adverse events such as pain, frozen shoulder and extension of the lesion compared to saline at more than 1 year of follow-up ( 26 ).…”