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Platelet-Rich Plasma (PRP) for Rotator Cuff Tears

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Musculoskeletal Injections Manual

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Abstract

Treatment of rotator cuff tears has advanced in recent years secondary to improvements in surgical techniques, instrumentation, and the use of orthobiologics. Namely, platelet-rich plasma (PRP) injections have emerged as a promising and innovative option in the management of rotator cuff tears, offering a nonsurgical alternative that utilizes the inherent healing potential of the body. PRP is derived from autologous blood, containing a supraphysiologic concentration of platelets, growth factors, and bioactive proteins that promote tissue healing and regeneration. The use of PRP injections in patients with rotator cuff tears has been theorized to decrease inflammation while promoting tissue healing to reduce pain and help restore shoulder function.

The purpose of this chapter is to examine the use of PRP injections as a therapeutic modality in the treatment of rotator cuff tears. Specifically, we explore the scientific basis behind the healing properties of PRP, discuss the procedural aspects of PRP injections, evaluate the clinical evidence supporting its effectiveness (or lack thereof), and highlight key considerations during patient selection and treatment protocols. Furthermore, we address potential limitations, side effects, and ongoing research to provide a comprehensive understanding of the current use of PRP injections in patients with rotator cuff tears.

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References

  1. Yanik EL, Chamberlain AM, Keener JD. Trends in rotator cuff repair rates and comorbidity burden among commercially insured patients younger than the age of 65 years, United States 2007-2016. JSES Rev Rep Tech. 2021;1(4):309–16.

    PubMed  PubMed Central  Google Scholar 

  2. Chalmers PN, Ross H, Granger E, Presson AP, Zhang C, Tashjian RZ. The effect of rotator cuff repair on natural history. JBJS Open Access. 2018;3(1):e0043.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Piper CC, Hughes AJ, Ma Y, Wang H, Neviaser AS. Operative versus nonoperative treatment for the management of full-thickness rotator cuff tears: a systematic review and meta-analysis. J Shoulder Elb Surg. 2018;27(3):572–6.

    Article  Google Scholar 

  4. Zhang C, Wu J, Li X, Wang Z, Lu WW, Wong T-M. Current biological strategies to enhance surgical treatment for rotator cuff repair. Front Bioeng Biotechnol. 2021;9:657584.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Khatri C, Ahmed I, Parsons H, et al. The natural history of full-thickness rotator cuff tears in randomized controlled trials: a systematic review and meta-analysis. Am J Sports Med. 2019;47(7):1734–43.

    Article  PubMed  Google Scholar 

  6. Viswanath A, Monga P. Trends in rotator cuff surgery: research through the decades. J Clin Orthop Trauma. 2021;18:105–13.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Hitchen J, Wragg NM, Shariatzadeh M, Wilson SL. Platelet rich plasma as a treatment method for rotator cuff tears. SN Compr Clin Med. 2020;2(11):2293–9.

    Article  Google Scholar 

  8. Gowd AK, Cabarcas BC, Frank RM, Cole BJ. Biologic augmentation of rotator cuff repair: the role of platelet-rich plasma and bone marrow aspirate concentrate. Oper Tech Sports Med. 2018;26(1):48–57.

    Article  Google Scholar 

  9. Oliva F, Gatti S, Porcellini G, Forsyth NR, Maffulli N. Growth factors and tendon healing. Med Sport Sci. 2012;57:53–64. Available from: https://www.karger.com/Article/FullText/328878.

    Article  PubMed  Google Scholar 

  10. Molloy T, Wang Y, Murrell GAC. The roles of growth factors in tendon and ligament healing. Sports Med. 2003;33(5):381–94. https://doi.org/10.2165/00007256-200333050-00004.

    Article  PubMed  Google Scholar 

  11. Lee YS, Kim JY, Ki SY, Chung SW. Influence of smoking on the expression of genes and proteins related to fat infiltration, inflammation, and fibrosis in the rotator cuff muscles of patients with chronic rotator cuff tears: a pilot study. Arthroscopy. 2019;35(12):3181–91. Available from: http://www.arthroscopyjournal.org/article/S0749806319306152/fulltext.

    Article  PubMed  Google Scholar 

  12. Kovacevic D, Fox AJ, Bedi A, et al. Calcium-phosphate matrix with or without TGF-β3 improves tendon-bone healing after rotator cuff repair. Am J Sports Med. 2011;39(4):811–9. https://doi.org/10.1177/0363546511399378.

    Article  PubMed  Google Scholar 

  13. Pufe T, Petersen WJ, Mentlein R, Tillmann BN. The role of vasculature and angiogenesis for the pathogenesis of degenerative tendons disease. Scand J Med Sci Sports. 2005;15(4):211–22. https://doi.org/10.1111/j.1600-0838.2005.00465.x.

    Article  CAS  PubMed  Google Scholar 

  14. Boswell SG, Cole BJ, Sundman EA, Karas V, Fortier LA. Platelet-rich plasma: a milieu of bioactive factors. Arthroscopy. 2012;28(3):429–39.

    Article  PubMed  Google Scholar 

  15. Chung SW, Song BW, Kim YH, Park KU, Oh JH. Effect of platelet-rich plasma and porcine dermal collagen graft augmentation for rotator cuff healing in a rabbit model. Am J Sports Med. 2013;41(12):2909–18. https://doi.org/10.1177/0363546513503810.

    Article  PubMed  Google Scholar 

  16. Peng Y, Li X, Wu W, et al. Effect of mechanical stimulation combined with platelet-rich plasma on healing of the rotator cuff in a murine model. Am J Sports Med. 2022;50(5):1358–68. https://doi.org/10.1177/03635465211073339.

    Article  PubMed  Google Scholar 

  17. Beck J, Evans D, Tonino PM, Yong S, Callaci JJ. The biomechanical and histologic effects of platelet-rich plasma on rat rotator cuff repairs. Am J Sports Med. 2012;40(9):2037–44. https://doi.org/10.1177/0363546512453300.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Chen X, Jones IA, Togashi R, Park C, Vangsness CT. Use of platelet-rich plasma for the improvement of pain and function in rotator cuff tears: a systematic review and meta-analysis with bias assessment. Am J Sports Med. 2020;48(8):2028–41.

    Article  PubMed  Google Scholar 

  19. Lin M-T, Wei K-C, Wu C-H. Effectiveness of platelet-rich plasma injection in rotator cuff tendinopathy: a systematic review and meta-analysis of randomized controlled trials. Diagnostics. 2020;10(4):189.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Hamid MS, Sazlina SG. Platelet-rich plasma for rotator cuff tendinopathy: a systematic review and meta-analysis. PLoS One. 2021;16(5):e0251111.

    Article  Google Scholar 

  21. Xu W, Xue Q. Application of platelet-rich plasma in arthroscopic rotator cuff repair: a systematic review and meta-analysis. Orthop J Sports Med. 2021;9(7):232596712110168.

    Article  Google Scholar 

  22. Yang FA, De Liao C, Wu CW, Shih YC, Wu LC, Chen HC. Effects of applying platelet-rich plasma during arthroscopic rotator cuff repair: a systematic review and meta-analysis of randomised controlled trials. Sci Rep. 2020;10(1):1–10. Available from: https://www.nature.com/articles/s41598-020-74341-0.

    Google Scholar 

  23. Peng Y, Li F, Ding Y, et al. Comparison of the effects of platelet-rich plasma and corticosteroid injection in rotator cuff disease treatment: a systematic review and meta-analysis. J Shoulder Elb Surg. 2023;32(6):1303–13.

    Article  Google Scholar 

  24. Adra M, El Ghazal N, Nakanishi H, et al. Platelet-rich plasma versus corticosteroid injections in the management of patients with rotator cuff disease: a systematic review and meta-analysis. J Orthop Res. 2023;41(1):7–20.

    Article  CAS  PubMed  Google Scholar 

  25. Pang L, Xu Y, Li T, Li Y, Zhu J, Tang X. Platelet-rich plasma injection can be a viable alternative to corticosteroid injection for conservative treatment of rotator cuff disease: a meta-analysis of randomized controlled trials. Arthroscopy. 2023;39(2):402–21.

    Article  PubMed  Google Scholar 

  26. Jiang X, Zhang H, Wu Q, Chen Y, Jiang T. Comparison of three common shoulder injections for rotator cuff tears: a systematic review and network meta-analysis. J Orthop Surg Res. 2023;18(1):272. https://doi.org/10.1186/s13018-023-03747-z.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Feltri P, Gonalba GC, Boffa A, et al. Platelet-rich plasma does not improve clinical results in patients with rotator cuff disorders but reduces the retear rate. A systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2022;60(6):465–75.

    Google Scholar 

  28. Galatz LM, Ball CM, Teefey SA, Middleton WD, Yamaguchi K. The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. J Bone Joint Surg Am. 2004;86(2):219–24. Available from: https://pubmed.ncbi.nlm.nih.gov/14960664/.

    Article  PubMed  Google Scholar 

  29. Trantos IA, Vasiliadis ES, Giannoulis FS, Pappa E, Kakridonis F, Pneumaticos SG. The effect of PRP augmentation of arthroscopic repairs of shoulder rotator cuff tears on postoperative clinical scores and retear rates: a systematic review and meta-analysis. J Clin Med. 2023;12(2):581.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Warth RJ, Dornan GJ, James EW, Horan MP, Millett PJ. Clinical and structural outcomes after arthroscopic repair of full-thickness rotator cuff tears with and without platelet-rich product supplementation: a meta-analysis and meta-regression. Arthroscopy. 2015;31(2):306–20. Available from: https://pubmed.ncbi.nlm.nih.gov/25450417/.

    Article  PubMed  Google Scholar 

  31. Zumstein MA, Jost B, Hempel J, Hodler J, Gerber C. The clinical and structural long-term results of open repair of massive tears of the rotator cuff. J Bone Joint Surg Am. 2008;90(11):2423–31. Available from: https://pubmed.ncbi.nlm.nih.gov/18978411/.

    Article  PubMed  Google Scholar 

  32. Ranebo MC, Björnsson Hallgren HC, Norlin R, Adolfsson LE. Clinical and structural outcome 22 years after acromioplasty without tendon repair in patients with subacromial pain and cuff tears. J Shoulder Elb Surg. 2017;26(7):1262–70. Available from: https://pubmed.ncbi.nlm.nih.gov/28131687/.

    Article  Google Scholar 

  33. Zingg PO, Jost B, Sukthankar A, Buhler M, Pfirrmann CWA, Gerber C. Clinical and structural outcomes of nonoperative management of massive rotator cuff tears. J Bone Joint Surg. 2007;89(9):1928–34.

    Article  CAS  PubMed  Google Scholar 

  34. Vavken P, Sadoghi P, Palmer M, et al. Platelet-rich plasma reduces retear rates after arthroscopic repair of small- and medium-sized rotator cuff tears but is not cost-effective. Am J Sports Med. 2015;43(12):3071–6.

    Article  PubMed  Google Scholar 

  35. Carr AJ, Murphy R, Dakin SG, et al. Platelet-rich plasma injection with arthroscopic acromioplasty for chronic rotator cuff tendinopathy: a randomized controlled trial. Am J Sports Med. 2015;43(12):2891–7. Available from: https://pubmed.ncbi.nlm.nih.gov/26498958/.

    Article  PubMed  Google Scholar 

  36. Pandey V, Bandi A, Madi S, et al. Does application of moderately concentrated platelet-rich plasma improve clinical and structural outcome after arthroscopic repair of medium-sized to large rotator cuff tear? A randomized controlled trial. J Shoulder Elb Surg. 2016;25(8):1312–22. Available from: http://www.jshoulderelbow.org/article/S1058274616300295/fulltext.

    Article  Google Scholar 

  37. Dukan R, Bommier A, Rousseau MA, Boyer P. Arthroscopic knotless tape bridging with autologous platelet-rich fibrin gel augmentation: functional and structural results. Phys Sportsmed. 2019;47(4):455–62. Available from: https://pubmed.ncbi.nlm.nih.gov/31136263/.

    Article  PubMed  Google Scholar 

  38. Malavolta EA, Gracitelli MEC, Assunção JH, Ferreira Neto AA, Bordalo-Rodrigues M, de Camargo OP. Clinical and structural evaluations of rotator cuff repair with and without added platelet-rich plasma at 5-year follow-up: a prospective randomized study. Am J Sports Med. 2018;46(13):3134–41. Available from: https://pubmed.ncbi.nlm.nih.gov/30234999/.

    Article  PubMed  Google Scholar 

  39. Baksh N, Hannon CP, Murawski CD, Smyth NA, Kennedy JG. Platelet-rich plasma in tendon models: a systematic review of basic science literature. Arthroscopy. 2013;29(3):596–607.

    Article  PubMed  Google Scholar 

  40. Fice MP, Miller JC, Christian R, et al. The role of platelet-rich plasma in cartilage pathology: an updated systematic review of the basic science evidence. Arthroscopy. 2019;35(3):961–976.e3.

    Article  PubMed  Google Scholar 

  41. Kunze KN, Hannon CP, Fialkoff JD, Frank RM, Cole BJ. Platelet-rich plasma for muscle injuries: a systematic review of the basic science literature. World J Orthop. 2019;10(7):278–91.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Chahla J, Cinque ME, Piuzzi NS, et al. A call for standardization in platelet-rich plasma preparation protocols and composition reporting: a systematic review of the clinical orthopaedic literature. J Bone Joint Surg. 2017;99(20):1769–79. Available from: https://journals.lww.com/jbjsjournal/Fulltext/2017/10180/A_Call_for_Standardization_in_Platelet_Rich_Plasma.9.aspx.

    Article  PubMed  Google Scholar 

  43. Hitchen J, Wragg NM, Shariatzadeh M, Wilson SL. Platelet rich plasma as a treatment method for rotator cuff tears. SN Comprehensive Clin Med. 2020;2(11):2293–9. https://doi.org/10.1007/s42399-020-00500-z.

    Article  Google Scholar 

  44. Ersen A, Demirhan M, Atalar AC, Kapicioǧlu M, Baysal G. Platelet-rich plasma for enhancing surgical rotator cuff repair: evaluation and comparison of two application methods in a rat model. Arch Orthop Trauma Surg. 2014;134(3):405–11. https://doi.org/10.1007/s00402-013-1914-3.

    Article  PubMed  Google Scholar 

  45. Carofino B, Chowaniec DM, McCarthy MB, et al. Corticosteroids and local anesthetics decrease positive effects of platelet-rich plasma: an in vitro study on human tendon cells. Arthroscopy. 2012;28(5):711–9. Available from: http://www.arthroscopyjournal.org/article/S0749806311011935/fulltext.

    Article  PubMed  Google Scholar 

  46. Bhan K, Singh B, Bhan K, Singh B. Efficacy of platelet-rich plasma injection in the management of rotator cuff tendinopathy: a review of the current literature. Cureus. 2022;14:6. Available from: https://www.cureus.com/articles/102283-efficacy-of-platelet-rich-plasma-injection-in-the-management-of-rotator-cuff-tendinopathy-a-review-of-the-current-literature.

    Google Scholar 

  47. Pifer MA, Maerz T, Baker KC, Anderson K. Matrix metalloproteinase content and activity in low-platelet, low-leukocyte and high-platelet, high-leukocyte platelet rich plasma (PRP) and the biologic response to PRP by human ligament fibroblasts. Am J Sports Med. 2014;42(5):1211–8. https://doi.org/10.1177/0363546514524710.

    Article  PubMed  Google Scholar 

  48. Zhou Y, Zhang J, Wu H, Hogan MCV, Wang JHC. The differential effects of leukocyte-containing and pure platelet-rich plasma (PRP) on tendon stem/progenitor cells - implications of PRP application for the clinical treatment of tendon injuries. Stem Cell Res Ther. 2015;6:1. Available from: https://pubmed.ncbi.nlm.nih.gov/26373929/.

    Article  Google Scholar 

  49. Rossi LA, Piuzzi N, Tanoira I, Brandariz R, Huespe I, Ranalletta M. Subacromial platelet-rich plasma injections produce significantly worse improvement in functional outcomes in patients with partial supraspinatus tears than in patients with isolated tendinopathy. Arthroscopy. 2023;39(9):2000–8.

    Article  PubMed  Google Scholar 

  50. Cross JA, Cole BJ, Spatny KP, et al. Leukocyte-reduced platelet-rich plasma normalizes matrix metabolism in torn human rotator cuff tendons. Am J Sports Med. 2015;43(12):2898–906.

    Article  PubMed  Google Scholar 

  51. Peng Y, Guanglan W, Jia S, Zheng C. Leukocyte-rich and leukocyte-poor platelet-rich plasma in rotator cuff repair: a meta-analysis. Int J Sports Med. 2022;43(11):921–30. Available from: http://www.thieme-connect.com/products/ejournals/html/10.1055/a-1790-7982.

    Article  CAS  PubMed  Google Scholar 

  52. Hurley ET, Colasanti CA, Anil U, et al. The effect of platelet-rich plasma leukocyte concentration on arthroscopic rotator cuff repair: a network meta-analysis of randomized controlled trials. Am J Sports Med. 2020;49(9):2528–35. https://doi.org/10.1177/0363546520975435.

    Article  PubMed  Google Scholar 

  53. Ahmad Z, Ang S, Rushton N, et al. Platelet-rich plasma augmentation of arthroscopic rotator cuff repair lowers retear rates and improves short-term postoperative functional outcome scores: a systematic review of meta-analyses. Arthrosc Sports Med Rehabil. 2022;4(2):823–33.

    Article  Google Scholar 

  54. Zhao D, Han Y, Hong, Pan J, et al. The clinical efficacy of leukocyte-poor platelet-rich plasma in arthroscopic rotator cuff repair: a meta-analysis of randomized controlled trials. J Shoulder Elb Surg. 2021;30(4):918–28.

    Article  Google Scholar 

  55. Parisien RL, Ehlers C, Cusano A, Tornetta P, Li X, Wang D. The statistical fragility of platelet-rich plasma in rotator cuff surgery: a systematic review and meta-analysis. Am J Sports Med. 2021;49(12):3437–42.

    Article  PubMed  Google Scholar 

  56. DeClercq MG, Fiorentino AM, Lengel HA, et al. Systematic review of platelet-rich plasma for rotator cuff repair: are we adhering to the minimum information for studies evaluating biologics in orthopaedics? Orthop J Sports Med. 2021;9(12):232596712110419.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Midwest Orthopaedics at Rush University Medical Center, Chicago, IL, USA

    Ron Gilat, Grant Garrigues, Nikhil Verma & Brian J. Cole

  2. Department of Orthopaedic Surgery, Shamir Medical Center and Tel Aviv University, Tel Aviv, Israel

    Ron Gilat & Ilan Y. Mitchnik

  3. Department of Orthopaedic Surgery, Washington University Sports Medicine, St. Louis, MO, USA

    Derrick Knapik

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  1. Ron Gilat
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  2. Ilan Y. Mitchnik
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  3. Derrick Knapik
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  4. Grant Garrigues
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  5. Nikhil Verma
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  6. Brian J. Cole
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Editors and Affiliations

  1. Acibadem Mehmet Ali Aydinlar University Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul, Türkiye

    Baris Kocaoglu

  2. Hilll Yaffe Medical Center (HYMC), Technion University Hospital, Hadera, Israel

    Lior Laver

  3. Orthopaedic Biotechnology Laboratory, Ospedale Galeazzi Sant'Ambrogio, Milano, Italy

    Laura de Girolamo

  4. Clinica Ortopedica, 1°, Istituto Ortopedico Gaetano Pini, Milano, Italy

    Riccardo Compagnoni

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Gilat, R., Mitchnik, I.Y., Knapik, D., Garrigues, G., Verma, N., Cole, B.J. (2024). Platelet-Rich Plasma (PRP) for Rotator Cuff Tears. In: Kocaoglu, B., Laver, L., Girolamo, L.d., Compagnoni, R. (eds) Musculoskeletal Injections Manual. Springer, Cham. https://doi.org/10.1007/978-3-031-52603-9_16

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