Aprospective cohort study indicates that platelet-rich plasma (PRP) injection may be a safe and cost-effective treatment alternative for rotator cuff tendinopathy (RCT) without a full-thickness tear of the rotator cuff. The results are presented in Scientific Poster P318, “Platelet Rich Plasma Injection as an Alternative Treatment for Rotator Cuff Tendinitis of Shoulder,” selected as the 2013 Best Poster in the Shoulder and Elbow category, on display in Academy Hall B.
In recent years, PRP has emerged as an effective treatment option for various tendinopathies throughout the body, including the rotator cuff tendon. Turlough O’Donnell, MD, and his colleague Aamir H. Shaikh, MSc, MRCSEd, MCh, of UPMC Beacon Hospital in Dublin, Ireland, sought to evaluate the therapeutic effects of multiple PRP injections administered directly into the supraspinatus tendon, compared with use of corticosteroid injections, in the treatment of RCT.
They prospectively identified 204 patients with poor shoulder function based on Constant-Murley (CMS) shoulder scores and shoulder pain that restricted range of motion (ROM). Only patients with full passive ROM and MRI–confirmed Goutallier grade 2 or less fatty infiltration were included.
Patients were divided into two age- and sex-matched cohorts. The PRP group (n = 102) was treated with PRP injections administered directly into the suprasimatos tendon; the control group (n =102) was treated with 20 mL solution of 0.05 percent bupivacaine and 80 mgs of methylprednisolone into the subacromial space.
Visual analog scale (VAS) pain scores, ROM, and Constant shoulder scores were obtained in all patients 3 months after final injection.
PRP found safe, effective
At 3 months post-injection, the researchers found clinically and statistically significant improvement in VAS pain scores, ROM, and mean Constant scores in both cohorts compared with pre-injection scores (P < 0.001). Although patients in the control group initially had a higher mean CMS score (49.68 vs 48.86), and patients in both groups showed significant improvement after receiving the injections (60.99 vs 80.43), the degree of change in the PRP group was significantly better than in the control group (P = 0.05).
Patients in the PRP group also had significantly better active forward flexion, abduction, and internal rotation at final follow-up than did those in the control group. The mean difference in Constant scores post-injection in the two groups was 19.4. According to the researchers, when this change of estimated means was plotted against pre-injection scores using analysis of variance, the increase in scores was clearly greater in the PRP group than in the steroid group (67.7 percent and 24.9 percent, respectively). In addition, at 1-year follow-up, only 3 patients in the PRP group had undergone surgery for recalcitrant pain, whereas 48 patients in the corticosteroid group had required surgical intervention.
“At 12-month follow-up, patients who received a series of PRP injections were 16 times less likely to have undergone surgical intervention than patients who received corticosteroid injections,” the authors said. The authors concluded that PRP injections are a clinically safe and cost-effective treatment alternative to corticosteroid injections for RCT pain.