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http://dx.doi.org/10.5397/cise.2021.00353

Can platelet-rich plasma injections provide better pain relief and functional outcomes in persons with common shoulder diseases: a meta-analysis of randomized controlled trials  

Barman, Apurba (Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences)
Mishra, Archana (Department of Pharmacology, All India Institute of Medical Sciences)
Maiti, Rituparna (Department of Pharmacology, All India Institute of Medical Sciences)
Sahoo, Jagannatha (Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences)
Thakur, Kaustav Basu (Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences)
Sasidharan, Sreeja Kamala (Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences)
Publication Information
Clinics in Shoulder and Elbow / v.25, no.1, 2022 , pp. 73-89 More about this Journal
Abstract
Background: To evaluate the efficacy of autologous platelet-rich plasma (PRP) injections in the treatment of common shoulder diseases. Methods: The PubMed, Medline, and Central databases and trial registries were searched from their inception to October 2020 for randomized controlled trials of autologous PRP injections for shoulder diseases versus placebo or any control intervention. Preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were followed in the selection, analysis, and reporting of findings. The primary outcome was pain intensity (visual analog scale), and secondary outcomes were changes in function and quality of life (QoL). Results: A total of 17 randomized controlled trials of PRP versus control were analyzed. From 8-12 weeks to ≥1 year, PRP injections were associated with better pain relief and functional outcomes than control interventions. PRP injections were also associated with greater QoL, with an effect size of 2.61 (95% confidence interval, 2.01-14.17) at medium-term follow-up. Compared with placebo and corticosteroid injections, PRP injections provided better pain relief and functional improvement. In subgroup analyses, trials in which PRP was prepared by the double centrifugation technique, the platelet concentration in the PRP was enriched ≥5 times, leucocyte-rich PRP was used, or an activating agent was used before application reported the most effective pain relief at 6-7 months. Conclusions: PRP injections could provide better pain relief and functional outcomes than other treatments for persons presenting with common shoulder diseases. PRP injections have a greater capacity to improve shoulder-related QoL than other interventions.
Keywords
Injections; Platelet-rich plasma; Shoulder; Pain; Meta-analysis;
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1 Zhu Y, Jin Z, Wang J, Chen S, Hu Y, Ren L, Wang Y, Song Q, Tian X, Xie F, Peng J, Peng N, Luo Y, Wang Y. Ultrasound-guided platelet-rich plasma injection and multimodality ultrasound examination of peripheral nerve crush injury. NPJ Regen Med 2020;5:21.   DOI
2 Kelly AM. The minimum clinically significant difference in visual analogue scale pain score does not differ with severity of pain. Emerg Med J 2001;18:205-7.   DOI
3 Kothari SY, Srikumar V, Singh N. Comparative Efficacy of Platelet Rich Plasma Injection, Corticosteroid Injection and Ultrasonic Therapy in the Treatment of Periarthritis Shoulder. J Clin Diagn Res 2017;11:RC15-8.
4 Smid P, Hart R, Komzak M, Pasa L, Puskeiler M. Treatment of the shoulder impingement syndrome with PRP injection. Acta Chir Orthop Traumatol Cech 2018;85:261-5.
5 Barman A, Mukherjee S, Sahoo J, Maiti R, Rao PB, Sinha MK, Sahoo D, Tripathy SK, Patro BK, Bag ND. 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;98:549-57.   DOI
6 Samy TM, Khater AH, Ahmed AK. Systematic review of literature on the efficiency of using PRP in arthroscopic rotator cuff repair. QJM 2020;113(Suppl 1):hcaa059.013.   DOI
7 Rha DW, Park GY, Kim YK, Kim MT, Lee SC. Comparison of the therapeutic effects of ultrasound-guided platelet-rich plasma injection and dry needling in rotator cuff disease: a randomized controlled trial. Clin Rehabil 2013;27:113-22.   DOI
8 Lin MT, Chiang CF, Wu CH, Huang YT, Tu YK, Wang TG. 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;100:336-49.   DOI
9 Sheth U, Simunovic N, Klein G, Fu F, Einhorn TA, Schemitsch E, Ayeni OR, Bhandari M. Efficacy of autologous platelet-rich plasma use for orthopaedic indications: a meta-analysis. J Bone Joint Surg Am 2012;94:298-307.   DOI
10 Roquelaure Y, Ha C, Leclerc A, Touranchet A, Sauteron M, Melchior M, Imbernon E, Goldberg M. Epidemiologic surveillance of upper-extremity musculoskeletal disorders in the working population. Arthritis Rheum 2006;55:765-78.   DOI
11 Liao HT, Marra KG, Rubin JP. Application of platelet-rich plasma and platelet-rich fibrin in fat grafting: basic science and literature review. Tissue Eng Part B Rev 2014;20:267-76.   DOI
12 Schwitzguebel AJ, Kolo FC, Tirefort J, Kourhani A, Nowak A, Gremeaux V, Saffarini M, Ladermann A. Efficacy of Platelet-Rich Plasma for the Treatment of Interstitial Supraspinatus Tears: A Double-Blinded, Randomized Controlled Trial. Am J Sports Med 2019;47:1885-92.   DOI
13 Wongworawat MD. Treatment of rotator cuff syndrome with injection of autologous platelet rich plasma [Internet]. Clinical-Trials.gov; 2014 [cited 2021 Aug 7]. Available from: https://clinicaltrials.gov/ct2/show/results/NCT01123889.
14 Ibrahim DH, El-Gazzar NM, El-Saadany HM, El-Khouly RM. 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. Egypt Rheumatologist 2019;41:157-61.   DOI
15 Wesner M, Defreitas T, Bredy H, Pothier L, Qin Z, McKillop AB, Gross DP. A Pilot Study Evaluating the Effectiveness of Platelet-Rich Plasma Therapy for Treating Degenerative Tendinopathies: A Randomized Control Trial with Synchronous Observational Cohort. PLoS One 2016;11:e0147842.   DOI
16 Shams A, El-Sayed M, Gamal O, Ewes W. Subacromial injection of autologous platelet-rich plasma versus corticosteroid for the treatment of symptomatic partial rotator cuff tears. Eur J Orthop Surg Traumatol 2016;26:837-42.   DOI
17 Moraes VY, Lenza M, Tamaoki MJ, Faloppa F, Belloti JC. Platelet-rich therapies for musculoskeletal soft tissue injuries. Cochrane Database Syst Rev 2014;2014:CD010071.
18 Cai YU, Sun Z, Liao B, Song Z, Xiao T, Zhu P. Sodium Hyaluronate and Platelet-Rich Plasma for Partial-Thickness Rotator Cuff Tears. Med Sci Sports Exerc 2019;51:227-33.
19 Nejati P, Ghahremaninia A, Naderi F, Gharibzadeh S, Mazaherinezhad A. Treatment of Subacromial Impingement Syndrome: Platelet-Rich Plasma or Exercise Therapy? A Randomized Controlled Trial. Orthop J Sports Med 2017;5:2325967117702366.
20 Wang C, Xu M, Guo W, Wang Y, Zhao S, Zhong L. Clinical efficacy and safety of platelet-rich plasma in arthroscopic full-thickness rotator cuff repair: A meta-analysis. PLoS One 2019;14:e0220392.   DOI
21 Upadhyay S, Jorule K, Varma HS, Chansoria M. Ongoing efficacy of platelet-rich plasma vs corticosteroid injection in patients with adhesive capsulitis: a prospective randomized assessor-blind comparative analysis. J Recent Adv Pain 2020;6:10-6.   DOI
22 Jeyaraman M, Ramesh R, Prajwal GS, Dhamsania HJ. The comparative and prospective study on Efficacy and functional outcome of autologous platelet rich plasma injection vs hydrodissection in adhesive capsulitis of shoulder. Int J Res Orthop 2018;4:848-53.   DOI
23 Han C, Na Y, Zhu Y, Kong L, Eerdun T, Yang X, Ren Y. Is platelet-rich plasma an ideal biomaterial for arthroscopic rotator cuff repair? A systematic review and meta-analysis of randomized controlled trials. J Orthop Surg Res 2019;14:183.   DOI
24 Hurley ET, Lim Fat D, Moran CJ, Mullett H. The Efficacy of Platelet-Rich Plasma and Platelet-Rich Fibrin in Arthroscopic Rotator Cuff Repair: A Meta-analysis of Randomized Controlled Trials. Am J Sports Med 2019;47:753-61.   DOI
25 Lin MT, Wei KC, Wu CH. Effectiveness of Platelet-Rich Plasma Injection in Rotator Cuff Tendinopathy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Diagnostics (Basel) 2020;10:189.   DOI
26 Hurley ET, Hannon CP, Pauzenberger L, Fat DL, Moran CJ, Mullett H. Nonoperative Treatment of Rotator Cuff Disease With Platelet-Rich Plasma: A Systematic Review of Randomized Controlled Trials. Arthroscopy 2019;35:1584-91.   DOI
27 Chen X, Jones IA, Park C, Vangsness CT Jr. 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;46:2020-32.   DOI
28 Bendinelli P, Matteucci E, Dogliotti G, Corsi MM, Banfi G, Maroni P, Desiderio MA. Molecular basis of anti-inflammatory action of platelet-rich plasma on human chondrocytes: mechanisms of NF-κB inhibition via HGF. J Cell Physiol 2010;225:757-66.   DOI
29 Lee HR, Park KM, Joung YK, Park KD, Do SH. Platelet-rich plasma loaded hydrogel scaffold enhances chondrogenic differentiation and maturation with up-regulation of CB1 and CB2. J Control Release 2012;159:332-7.   DOI
30 Strauss FJ, Nasirzade J, Kargarpoor Z, Stahli A, Gruber R. Effect of platelet-rich fibrin on cell proliferation, migration, differentiation, inflammation, and osteoclastogenesis: a systematic review of in vitro studies. Clin Oral Investig 2020;24:569-84.   DOI
31 van den Dolder PA, Ferreira PH, Refshauge KM. Effectiveness of soft tissue massage and exercise for the treatment of non-specific shoulder pain: a systematic review with meta-analysis. Br J Sports Med 2014;48:1216-26.   DOI
32 Miller LE, Parrish WR, Roides B, Bhattacharyya S. Efficacy of platelet-rich plasma injections for symptomatic tendinopathy: systematic review and meta-analysis of randomised injectioncontrolled trials. BMJ Open Sport Exerc Med 2017;3:e000237.   DOI
33 Simman R, Hoffmann A, Bohinc RJ, Peterson WC, Russ AJ. Role of platelet-rich plasma in acceleration of bone fracture healing. Ann Plast Surg 2008;61:337-44.   DOI
34 Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA, PRISMA-P Group. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 2015;4:1.   DOI
35 de Witte PB, Henseler JF, Nagels J, Vliet Vlieland TP, Nelissen RG. The Western Ontario rotator cuff index in rotator cuff disease patients: a comprehensive reliability and responsiveness validation study. Am J Sports Med 2012;40:1611-9.   DOI
36 Barreto RB, Azevedo AR, Gois MC, Freire MRM, Silva DS, Cardoso JC. Platelet-Rich Plasma and Corticosteroid in the Treatment of Rotator Cuff Impingement Syndrome: Randomized Clinical Trial. Rev Bras Ortop (Sao Paulo) 2019;54:636-43.   DOI
37 Ilhanli I, Guder N, Gul M. Platelet-Rich Plasma Treatment With Physical Therapy in Chronic Partial Supraspinatus Tears. Iran Red Crescent Med J 2015;17:e23732.   DOI
38 Kesikburun S, Tan AK, Yilmaz B, Yasar E, Yazicioglu K. Platelet-rich plasma injections in the treatment of chronic rotator cuff tendinopathy: a randomized controlled trial with 1-year follow-up. Am J Sports Med 2013;41:2609-16.   DOI
39 Pasin T, Ataoglu S, Pasin O, Ankarali H. Comparison of the Effectiveness of Platelet-Rich Plasma, Corticosteroid, and Physical Therapy in Subacromial Impingement Syndrome. Arch Rheumatol 2019;34:308-16.   DOI
40 Sari A, Eroglu A. Comparison of ultrasound-guided platelet-rich plasma, prolotherapy, and corticosteroid injections in rotator cuff lesions. J Back Musculoskelet Rehabil 2020;33:387-96.   DOI