Skip to main content

Advertisement

SpringerLink
Log in

Subacromial injection of autologous platelet-rich plasma versus corticosteroid for the treatment of symptomatic partial rotator cuff tears

  • Original Article • SHOULDER - ARTHROSCOPY
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Objective

Rotator cuff tears are one of the most common causes of chronic shoulder pain and disability. They significantly affect the quality of life. Reduced pain and improved function are the goals of conventional therapy, which includes relative rest, pain therapy, physical therapy, corticosteroid injections and surgical intervention. Tendons have a relative avascular nature; hence, their regenerative potential is limited. There is some clinical evidence that the application of autologous platelets may help to revascularize the area of injury in rotator cuff pathologies.

Patients and methods

This prospective randomized controlled study was done to evaluate the results of subacromial injection of platelet-rich plasma (PRP) versus corticosteroid injection therapy in 40 patients with symptomatic partial rotator cuff tears. All patients were assessed before injection, 6 weeks, 3 and 6 months after injection, using the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), the Constant–Murley Score (CMS), the Simple Shoulder Test (SST) and a Visual Analog Scale (VAS) for pain. An MRI was performed before and 6 months after the injection for all the included patients and was graded on 0–5 scale.

Results

Both injection groups showed statistically significantly better clinical outcomes over time compared with those before injection. There was a statistically significant difference between RPP group and corticosteroid group 12 weeks after injection, regarding VAS, ASES, CMS and SST in favor of the RPP group. MRI showed an overall slight nonsignificant improvement in grades of tendinopathy/tear in both groups, however, without statistically significant differences between the two groups.

Conclusion

PRP injections showed earlier better results as compared to corticosteroid injections, although statistically significant better results after 6 months could not be found. Therefore, subacromial RPP injection could be considered as a good alternative to corticosteroid injection, especially in patients with a contraindication to corticosteroid administration.

Level of evidence

II.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Chakravarty K, Webley M (1993) Shoulder joint movement and its relationship to disability in the elderly. J Rheumatol 20(8):1359–1361

    CAS  PubMed  Google Scholar 

  2. Kim HM, Dahiya N, Teefey SA et al (2010) Location and initiation of degenerative rotator cuff tears. J Bone Joint Surg (Am) 92(5):1088–1096

    Article  Google Scholar 

  3. Ho JO, Sawadkar P, Mudera V (2014) A review on the use of cell therapy in the treatment of tendon disease and injuries. J Tissue Eng 18(5):204–213

    Google Scholar 

  4. Anitua E, Andía I, Sanchez M et al (2005) Autologous preparations rich in growth factors promote proliferation and induce VEGF and HGF production by human tendon cells in culture. J Orthop Res 23:281–286

    Article  CAS  PubMed  Google Scholar 

  5. De Vos RJ, Weir A, Van Schie HT et al (2010) Platelet-rich plasma injection for chronic Achilles tendinopathy: a randomized controlled trial. JAMA 303(2):144–149

    Article  PubMed  Google Scholar 

  6. Peerbooms JC, Sluimer J, Bruijn DJ, Gosens T (2010) Positive effect of an autologous platelet concentrate in lateral epicondylitis in a double-blind randomized controlled trial: platelet-rich plasma versus corticosteroid injection with a 1-year follow-up. Am J Sports Med 38(2):255–262

    Article  PubMed  Google Scholar 

  7. Randelli P, Arrigoni P, Ragone V, Aliprandi A, Cabitza P (2011) Platelet rich plasma in arthroscopic rotator cuff repair: a prospective RCT study, 2-year follow-up. J Shoulder Elbow Surg 20:518–528

    Article  PubMed  Google Scholar 

  8. Richards RR, An KN, Bigliani LU et al (1994) A standardized method for the assessment of shoulder function. J Shoulder Elbow Surg 3(6):347–352

    Article  CAS  PubMed  Google Scholar 

  9. Constant CR, Murley AG (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164

    Google Scholar 

  10. Lippitt SB, Harryman DT, Matsen FA, Fu FH, Hawkins RJ (1993) A practical tool for evaluating function: the simple shoulder test. In: Matsen F (ed) The shoulder: a balance of mobility and stability, American Academy of Orthopaedic Surgeons, pp 501–18

  11. Lewis JS (2010) Rotator cuff tendinopathy: a model for the continuum of pathology and related management. Br J Sports Med 44(13):918–923

    Article  PubMed  Google Scholar 

  12. Scarpone M, Rabago D, Snell E et al (2013) Effectiveness of platelet-rich plasma injection for rotator cuff tendinopathy: a prospective open-label study. Glob Adv Health Med 2(2):26–31

    Article  PubMed  PubMed Central  Google Scholar 

  13. Molini L, Mariacher S, Bianchi S (2012) US guided corticosteroid injection into the subacromial-subdeltoid bursa: technique and approach. J Ultrasound 15(1):61–68

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Zheng XQ, Li K, Wei YD, Tie HT, Yi XY, Huang W (2014) Nonsteroidal anti-inflammatory drugs versus corticosteroid for treatment of shoulder pain: a systematic review and meta-analysis. Arch Phys Med Rehabil 95(10):1824–1831

    Article  PubMed  Google Scholar 

  15. Haraldsson BT, Langberg H, Aagaard P, Zuurmond AM, Van El B, Degroot J et al (2006) Corticosteroids reduce the tensile strength of isolated collagen fascicles. Am J Sports Med 34(12):1992–1997

    Article  PubMed  Google Scholar 

  16. Hansen M, Boesen A, Holm L, Flyvbjerg A, Langberg H, Kjaer M (2013) Local administration of insulin-like growth factor-I (IGF-I) stimulates tendon collagen synthesis in humans. Scand J Med Sci Sports 23(5):614–619

    CAS  PubMed  Google Scholar 

  17. Kaux JF, Janssen L, Drion P et al (2014) Vascular Endothelial Growth Factor-111 (VEGF-111) and tendon healing: preliminary results in a rat model of tendon injury. Muscles Ligaments Tendons J 4(1):24–28

    PubMed  PubMed Central  Google Scholar 

  18. Rutgers M, Saris DB, Dhert WJ, Creemers LB (2010) Cytokine profile of autologous conditioned serum for treatment of osteoarthritis, in vitro effects on cartilage metabolism and intra-articular levels after injection. Arthritis Res Ther 12(3):213–222

    Article  CAS  Google Scholar 

  19. Cervellin M, De Girolamo L, Bait C, Denti M, Volpi P (2012) Autologous platelet-rich plasma gel to reduce donor-site morbidity after patellar tendon graft harvesting for anterior cruciate ligament reconstruction: a randomized, controlled clinical study. Knee Surg Sports Traumatol Arthrosc 20(1):114–120

    Article  CAS  PubMed  Google Scholar 

  20. Bosch G, Moleman M, Barneveld A, van Weeren PR, van Schie HT (2011) The effect of platelet-rich plasma on the neovascularization of surgically created equine superficial digital flexor tendon lesions. Scand J Med Sci Sports 21(4):554–561

    Article  CAS  PubMed  Google Scholar 

  21. Heisterbach PE, Todorov A, Fluckiger R, Evans CH, Majewski M (2012) Effect of BMP-12, TGF-beta1 and autologous conditioned serum on growth factor expression in Achilles tendon healing. Knee Surg Sports Traumatol Arthrosc 20(10):1907–1914

    Article  PubMed  Google Scholar 

  22. Nguyen RT, Borg-Stein J, McInnis K (2011) Applications of platelet-rich plasma in musculoskeletal and sports medicine: an evidence-based approach. PM R 3(3):226–250

    Article  PubMed  Google Scholar 

  23. Cook JL, Purdam CR (2009) Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load induced tendinopathy. Br J Sports Med 43(6):409–416

    Article  CAS  PubMed  Google Scholar 

  24. Rha DW, Park GY, Kim YK, Kim MT, Lee SC (2013) 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 27(2):113–122

    Article  PubMed  Google Scholar 

  25. Barber FA, Hrnack SA, Snyder SJ, Hapa O (2011) Rotator cuff repair healing influenced by platelet-rich plasma construct augmentation. Arthroscopy 27(8):1029–1035

    Article  PubMed  Google Scholar 

  26. Gumina S, Campagna V, Ferrazza G et al (2012) Use of platelet leukocyte membrane in arthroscopic repair of large rotator cuff tears: a prospective randomized study. J Bone Joint Surg Am 94(15):1345–1352

    Article  PubMed  Google Scholar 

  27. Randelli PS, Arrigoni P, Cabitza P, Volpi P, Maffulli N (2008) Autologous platelet rich plasma for arthroscopic rotator cuff repair. A pilot study. Disabil Rehabil 30(20–22):1584–1589

    Article  PubMed  Google Scholar 

  28. Jo CH, Shin JS, Lee YG et al (2013) Platelet-rich plasma for arthroscopic repair of large to massive rotator cuff tears: a randomized, single-blind, parallel-group trial. Am J Sports Med 41:2240–2248

    Article  PubMed  Google Scholar 

  29. Kesikburun S, Tan AK, Yilmaz B, Yasar E, Yazicioglu K (2013) 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 41(11):2609–2616

    Article  PubMed  Google Scholar 

  30. Antuna S, Barco R, Martinez Diez JM, Sanchez Marquez JM (2013) Platelet-rich fibrin in arthroscopic repair of massive rotator cuff tears: a prospective randomized pilot clinical trial. Acta Orthop Belg 79(1):25–30

    PubMed  Google Scholar 

  31. Castricini R, Longo UG, De BM et al (2011) Platelet-rich plasma augmentation for arthroscopic rotator cuff repair: a randomized controlled trial. Am J Sports Med 39(2):258–265

    Article  PubMed  Google Scholar 

  32. Weber SC, Kauffman JI, Parise C, Weber SJ, Katz SD (2013) Platelet-rich fibrin matrix in the management of arthroscopic repair of the rotator cuff: a prospective, randomized, double blinded study. Am J Sports Med 41(2):263–270

    Article  PubMed  Google Scholar 

  33. Chahal J, Van Thiel GS, Mall N et al (2012) The role of platelet rich plasma in arthroscopic rotator cuff repair: a systematic review with quantitative synthesis. Arthroscopy 28(11):1718–1727

    Article  PubMed  Google Scholar 

  34. Malavolta EA, Gracitelli ME, Ferreira Neto AA, Assuncao JH, Bordalo-Rodrigues M, De Camargo OP (2014) Platelet-rich plasma in rotator cuff repair: a prospective randomized study. Am J Sports Med 42(10):2446–2454

    Article  PubMed  Google Scholar 

  35. Zhang Q, Ge H, Zhou J, Cheng B (2013) Are platelet-rich products necessary during the arthroscopic repair of full-thickness rotator cuff tears: a meta-analysis. Am J Sports Med 22(4):213–221

    Google Scholar 

  36. Rodeo SA, Delos D, Williams RJ, Adler RS, Pearle A, Warren RF (2012) The effect of platelet-rich fibrin matrix on rotator cuff tendon healing: a prospective, randomized clinical study. Am J Sports Med 40(6):1234–1241

    Article  PubMed  Google Scholar 

  37. Jo CH, Kim JE, Yoon KS et al (2011) Does platelet-rich plasma accelerate recovery after rotator cuff repair? A prospective cohort study. Am J Sports Med 39(10):2082–2090

    Article  PubMed  Google Scholar 

  38. Ruiz-Moneo P, Molano-Munoz J, Prieto E, Algorta J (2013) Plasma rich in growth factors in arthroscopic rotator cuff repair: a randomized, double-blind, controlled clinical trial. Arthroscopy 29(1):2–9

    Article  PubMed  Google Scholar 

  39. Bergeson AG, Tashjian RZ, Greis PE, Crim J, Stoddard GJ, Burks RT (2012) Effects of platelet-rich fibrin matrix on repair integrity of at-risk rotator cuff tears. Am J Sports Med 40(2):286–293

    Article  PubMed  Google Scholar 

  40. Charousset C, Zaoui A, Bellaiche L, Piterman M (2014) Does autologous leukocyte-platelet-rich plasma improve tendon healing in arthroscopic repair of large or massive rotator cuff tears? Arthroscopy 30(4):428–435

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Orthopedic Surgery, Menofiya University, Al Minufya, Egypt

    Ahmed Shams & Osama Gamal

  2. Pediatric Orthopedics, Tanta University, 13 Omar Zafan St., 6th Floor., Tanta, Gharbia, 3111, Egypt

    Mohamed El-Sayed & Waled Ewes

Authors
  1. Ahmed Shams
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mohamed El-Sayed
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Osama Gamal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Waled Ewes
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mohamed El-Sayed.

Ethics declarations

Conflict of interest

The authors declare that there are no conflicts of interests for this study. No funds have been received for this study by any of the authors. It was performed at University Public Hospital. The presenting author, Mohamed El-Sayed, declares that he has no conflict of interest. The first author, Ahmed Shams, declares that he has no conflict of interest. The third author, Osama Gamal, declares that he has no conflict of interest. The fourth author, Waled Ewes, declares that he has no conflict of interest.

Ethical approval

This study was performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. It was conducted after approval of the university ethical committee, and a written approval statement was collected from all the included subjects before surgery. This study was conducted at Menofiya University Hospitals and Tanta University Hospitals.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shams, A., El-Sayed, M., Gamal, O. et al. Subacromial injection of autologous platelet-rich plasma versus corticosteroid for the treatment of symptomatic partial rotator cuff tears. Eur J Orthop Surg Traumatol 26, 837–842 (2016). https://doi.org/10.1007/s00590-016-1826-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-016-1826-3

Keywords

Search

Navigation