Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
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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)
  • Received : 2021.06.02
  • Accepted : 2021.07.26
  • Published : 2022.03.01
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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

References

  1. 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. https://doi.org/10.1002/art.22222
  2. 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. https://doi.org/10.1136/bjsports-2011-090553
  3. 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. https://doi.org/10.1177/0363546517743746
  4. 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. https://doi.org/10.1089/ten.teb.2013.0317
  5. 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. https://doi.org/10.1016/j.jconrel.2012.02.008
  6. 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. https://doi.org/10.1002/jcp.22274
  7. 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. https://doi.org/10.1007/s00784-019-03156-9
  8. 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. https://doi.org/10.1097/SAP.0b013e318157a185
  9. 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. https://doi.org/10.1038/s41536-020-00101-3
  10. 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. https://doi.org/10.1186/2046-4053-4-1
  11. 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. https://doi.org/10.1371/journal.pone.0147842
  12. 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. https://doi.org/10.1136/emj.18.3.205
  13. 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. https://doi.org/10.1177/0363546512446591
  14. 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. https://doi.org/10.1016/j.rboe.2018.03.002
  15. 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.
  16. 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. https://doi.org/10.5812/ircmj.23732
  17. 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. https://doi.org/10.1177/0363546513496542
  18. 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.
  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. 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. https://doi.org/10.5606/archrheumatol.2019.7225
  21. 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. https://doi.org/10.1177/0269215512448388
  22. 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. https://doi.org/10.3233/bmr-191519
  23. 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. https://doi.org/10.1177/0363546519851097
  24. 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. https://doi.org/10.1007/s00590-016-1826-3
  25. 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.
  26. 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. https://doi.org/10.1016/j.ejr.2018.06.004
  27. 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.
  28. 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. https://doi.org/10.5005/jp-journals-10046-0160
  29. 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. https://doi.org/10.18203/issn.2455-4510.intjresorthop20184190
  30. 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. https://doi.org/10.1097/PHM.0000000000001144
  31. 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. https://doi.org/10.1371/journal.pone.0220392
  32. 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. https://doi.org/10.1186/s13018-019-1207-9
  33. 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. https://doi.org/10.1093/qjmed/hcaa059
  34. 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. https://doi.org/10.1177/0363546517751397
  35. 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. https://doi.org/10.1016/j.arthro.2018.10.115
  36. 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. https://doi.org/10.1016/j.apmr.2018.06.028
  37. 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. https://doi.org/10.3390/diagnostics10040189
  38. 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. https://doi.org/10.1136/bmjsem-2017-000237
  39. 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. https://doi.org/10.2106/JBJS.K.00154
  40. 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.