Platelet-rich plasma injection vs corticosteroid injection for conservative treatment of rotator cuff lesions

Objectives: Calcific tendinitis of the shoulder is a painful condition characterized by the presence of calcium deposits within the tendons of the rotator cuff (RTC) that accounts for up to 7% of cases of shoulder pain1. The most common conservative treatments typically include physical therapy (PT), corticosteroid injection (CSI), or ultrasound-guided aspiration (USA). When conservative management fails, the patient may require arthroscopic surgery to remove the calcium with concomitant rotator cuff repair. The purpose of this study was to characterize the failure rates, defined as the need for surgery, of each of these three methods of conservative treatment, as well as to compare post-operative improvement in patient-reported outcomes (PROs) – including subjective shoulder values (SSV) and visual analog scale (VAS) pain scores – based on the type of pre-operative conservative intervention provided. A secondary aim was to compare post-operative range of motion (ROM) outcomes between groups that failed conservative management. We hypothesized that all preoperative conservative treatments would have equivalent success rates, PROs, and ROM. Bosworth B. Calcium deposits in the shoulder and subacromial bursitis: a survey of 12122 shoulders. JAMA. 1941;116(22):2477-2489. Methods: A retrospective review of all patients who were diagnosed with calcific tendinitis at our institution treated among 3 fellowship trained orthopedic surgeons between 2009 and 2019 was performed. VAS, SSV, and ROM in forward flexion (FF) and external rotation (ER) was abstracted from the medical records. Scores were recorded at the initial presentation as well as final post-operative follow-up visit for those who underwent surgery. The conservative treatment method utilized by each patient was recorded and included PT, CSI, or USA. Failure of conservative management was defined as eventual progression to surgical intervention. Statistical analysis included chi-square, independent t test and ANOVA. Descriptive statistics were used to report data. A p<0.05 was considered to be statistically significant. Results: 239 patients diagnosed with calcific tendinitis were identified in the study period with mean age of 54 years and follow up of at least 6 months. In all, 206 (86.2%) patients underwent a method of conservative treatment. Of these patients, 71/239 (29.7%) underwent PT, 67/239 (28%) attempted CSI, and 68/239 (28.5%) underwent USA. The overall failure rate across all treatment groups was 29.1%, with injections yielding the highest success rate of 54/67 (80.6%). Physical therapy saw the highest failure rate, with 26/71 (36.7%) proceeding to surgical intervention. Patients undergoing physical therapy were statistically more likely to require surgery compared to those undergoing corticosteroid injection (RR 1.88, p= 0.024). Of all 93 patients who underwent surgery, VAS, SSV, ROM improved significantly in all groups. On average, VAS decreased by 4.02 points (6.3 to 2.3), SSV increased by 33 points (51 to 84), FF improved by 13.8º, and ER improved 8.4º between the pre- and post-operative visits (p<0.05). The 33 patients who did not attempt a conservative pre-operative treatment demonstrated the largest post-operative improvement in VAS (-6.00), which was significantly greater than those who previously attempted PT (-3.33, p<0.05). There was a trend towards greater improvement in SSV in the pre-operative PT group (45 to 81) compared to others, but this did not reach statistical significance (p=0.47). Range of motion was not significantly affected by the method of pre-operative conservative intervention. Conclusions: Conservative treatment in the form of physical therapy, corticosteroid injection, and ultrasound-guided aspiration is largely successful in managing calcific tendinitis of the shoulder. Of these, PT demonstrated the highest rate of failure in terms of requiring surgical management. PRO improvement varied among the conservative modalities used, however patients who did not attempt conservative management experienced the greatest improvements following surgery. If surgery is necessary following failed conservative treatment, excellent outcomes can be expected with significant improvements in ROM and PROs. This information should be considered by the surgeon when deciding whether to recommend conservative treatment for the management of calcific tendinitis, as well as which specific method to employ.

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A comparative study of functional outcome between platelet rich plasma injection versus steroid infiltration in plantar fasciitis

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20200744 ◽

2020 ◽

Vol 6 (2) ◽

pp. 393

Author(s):

Harpreet Singh ◽

Malay P. Gandhi ◽

Aliasgar J. Rampurwala ◽

Tej S. Rudani

Keyword(s):

Comparative Study ◽

Plantar Fasciitis ◽

Platelet Rich Plasma ◽

Corticosteroid Injection ◽

Injection Group ◽

Plasma Injection ◽

Significant Difference ◽

The Difference ◽

The Individual

Background: Plantar fasciitis (PF) is considered as degenerative tendinopathies. Repeated micro trauma is the major etiology of these diseases. Autologous platelet rich plasma (PRP) injections are becoming more popular in the treatment of enthesopathies like PF. The growth factors in PRP cause tissue healing. We compared the result of injecting intra-lesional autologous PRP injections versus steroid infiltration in chronic PF.Methods: A prospective, interventional and analytic comparative study was done and 81 patients (120 heels) were included in this study and were followed up for 6 months. We assessed the outcome of each patient using visual analog score (VAS) and foot and ankle disability index (FADI) on follow-up at 1, 3, and 6 months. Results: In our study, female preponderance was seen. Left side was more common as compared to right side. Unilateral PF is more common than bilateral. The difference with in the individual group at baseline and at 1,3 and 6 months was statistically highly significant in terms of VAS and FADI (p=0.0001) But the difference in the between the two groups was insignificant for VAS and FADI at 1, 3 and 6 months.Conclusions: In our study, as there is no significant difference in VAS and FADI score between corticosteroid injection group and PRP injection group at 1, 3 and 6 months follow up. So, it’s reasonable to conclude that both are equally effective in PF. But as PRP injection comes out to be more time consuming and more costly, corticosteroid seems to be more efficient, cost and time wise. Hence, the latter should be a better choice.

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Treatment of Partial Rotator Cuff Tear with Ultrasound-guided Platelet-rich Plasma

Journal of Clinical Imaging Science ◽

10.4103/jcis.jcis_26_17 ◽

2017 ◽

Vol 7 ◽

pp. 32 ◽

Cited By ~ 11

Author(s):

Vetrivel Chezian Sengodan ◽

Sajith Kurian ◽

Raghupathy Ramasamy

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Tear ◽

Platelet Rich Plasma ◽

Rotator Cuff Tears ◽

Lateral Side ◽

Ultrasound Guided ◽

Cuff Tear ◽

Plasma Injection ◽

Partial Rotator Cuff Tear ◽

Shoulder Score

Background: The treatment of symptomatic partial rotator cuff tear has presented substantial challenge to orthopaedic surgeons as it can vary from conservative to surgical repair. Researches have established the influence of platelet rich plasma in healing damaged tissue. Currently very few data are available regarding the evidence of clinical and radiological outcome of partial rotator cuff tear treated with ultrasound guided platelet rich plasma injection in English literature. Materials and Methods: 20 patients with symptomatic partial rotator cuff tears were treated with ultrasound guided platelet rich plasma injection. Before and after the injection of platelet rich plasma scoring was done with visual analogue score, Constant shoulder score, and UCLA shoulder score at 8 weeks and third month. A review ultrasound was performed 8 weeks after platelet rich plasma injection to assess the rotator cuff status. Results: Our study showed statistically significant improvements in 17 patients in VAS pain score, constant shoulder score and UCLA shoulder score. No significant changes in ROM were noted when matched to the contra-lateral side (P < 0.001) at the 3 month follow-up. The study also showed good healing on radiological evaluation with ultrasonogram 8 weeks after platelet rich plasma injection. Conclusion: Ultrasound guided platelet rich plasma injection for partial rotator cuff tears is an effective procedure that leads to significant decrease in pain, improvement in shoulder functions, much cost-effective and less problematic compared to a surgical treatment.

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Single-dose intra-articular corticosteroid injection prior to platelet-rich plasma injection resulted in better clinical outcomes in patients with knee osteoarthritis: A pilot study

Journal of Back and Musculoskeletal Rehabilitation ◽

10.3233/bmr-171066 ◽

2018 ◽

Vol 31 (4) ◽

pp. 603-610 ◽

Cited By ~ 10

Author(s):

Yalkin Camurcu ◽

Hakan Sofu ◽

Hanifi Ucpunar ◽

Nizamettin Kockara ◽

Adem Cobden ◽

...

Keyword(s):

Single Dose ◽

Pilot Study ◽

Knee Osteoarthritis ◽

Clinical Outcomes ◽

Platelet Rich Plasma ◽

Corticosteroid Injection ◽

Plasma Injection

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Role of Ultrasound-Guided Platelet Rich Plasma Injection in Treatment of Chronic Rotator Cuff Muscles Tendinopathy

QJM ◽

10.1093/qjmed/hcaa068.012a ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

M A Nassef ◽

A E Allam ◽

H M N Mohammed

Keyword(s):

Rotator Cuff ◽

Range Of Motion ◽

Shoulder Pain ◽

Platelet Rich Plasma ◽

Clinical Manifestations ◽

Base Line ◽

Ultrasound Guided ◽

Plasma Injection ◽

Effective Treatment Modality ◽

Rotator Cuff Tendinopathy

Abstract Background shoulder pain is the third most common musculoskeletal complaint. And rotator cuff muscles tendinopathy is one of the most common causes for shoulder pain. Aim of the Work to evaluate the effectiveness of the percutaneous ultrasound guided PRP injection in improving or treating chronic Rotator Cuff muscles tendinopathy. Patients and Methods this study was conducted on 33 patients presented to Police Hospital Nasr City and diagnosed as cases of rotator cuff tendinopathy for more than 6 months and not responding to NSAIDs. Results there is high significant improvement of the ultrasound findings and clinical manifestations of patients as regard pain, range of motion and power comparing to the base line start. According to this study, PRP was found to be more effective on the long term then short term “comparing results after one and five month”. Conclusion ultrasound guided PRP injection is a safe and an effective treatment modality for rotator cuff tendinopathy as evidenced by decreased pain and improved range of motion across the shoulder joint after the application and follow up of the PRP.

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Platelet-Rich Plasma Injection With Arthroscopic Acromioplasty for Chronic Rotator Cuff Tendinopathy

The American Journal of Sports Medicine ◽

10.1177/0363546515608485 ◽

2015 ◽

Vol 43 (12) ◽

pp. 2891-2897 ◽

Cited By ~ 48

Author(s):

Andrew J. Carr ◽

Richard Murphy ◽

Stephanie G. Dakin ◽

Ines Rombach ◽

Kim Wheway ◽

...

Keyword(s):

Rotator Cuff ◽

Platelet Rich Plasma ◽

Plasma Injection ◽

Rotator Cuff Tendinopathy

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Prospective Clinical Research of the Efficacy of Platelet-rich Plasma in the Outpatient-based Treatment of Rotator Cuff Tendinopathy

Clinics in Shoulder and Elbow ◽

10.5397/cise.2019.22.2.61 ◽

2019 ◽

Vol 22 (2) ◽

pp. 61-69

Author(s):

Ho-Won Lee ◽

Kyung-Ho Choi ◽

Jung-Youn Kim ◽

Ik Yang ◽

Kyu-Cheol Noh

Keyword(s):

Rotator Cuff ◽

Conservative Treatment ◽

Rating Scale ◽

Platelet Rich Plasma ◽

Constant Score ◽

Statistical Significance ◽

Clinical Results ◽

Control Group ◽

Significant Difference ◽

Rotator Cuff Tendinopathy

Background: The purpose of this study is to compare the clinical outcomes of the control group and platelet-rich plasma (PRP) group among the patients who failed to respond to conservative treatment as outpatient-based therapy for rotator cuff tendinopathy, and to compare the clinical results of leukocyte-poor (LP) PRP and leukocyte-rich (LR) PRP.Methods: Inclusion criteria are (1) over 18-year-old, (2) patients with rotator cuff tendinopathy, no rotator cuff tear by radiologic diagnosis (ultrasonography or magnetic resonance imaging) within the last 3 months, and (3) not effective to conservative treatment for more than 1 month. Of the final 60 subjects, 33 patients in the exercise treatment group and 27 patients in the PRP injection group (LP-PRP, 13; LR-PRP, 14) were included. Clinical evaluation was carried out by assessing the outcomes of treatment using the Numeric Rating Scale pain score, the American Shoulder and Elbow Society (ASES) score, and the Constant score at baseline and at 3 and 6 months after the procedure.Results: There was a statistically significant difference in ΔASES3months (ASES3months-ASESfirst) score between the control and PRP groups (p=0.006). However, there was no statistical significance between LP-PRP and LR-PRP groups (p>0.05).Conclusions: This study showed that PRP injection was more effective than exercise therapy for the first 3 months. However, there was no difference between the LP-PRP group and the LR-PRP group. Regardless of the type of PRP, clinical application of PRP injection in patients with rotator cuff tendinopathy seems to be effective in early treatment.

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Comparison of ultrasound-guided platelet-rich plasma injection and conventional physical therapy for management of adhesive capsulitis: a randomized trial

Journal of International Medical Research ◽

10.1177/0300060520976032 ◽

2020 ◽

Vol 48 (12) ◽

pp. 030006052097603

Author(s):

Aung Chan Thu ◽

Sang Gyu Kwak ◽

Win Nyi Shein ◽

La Min Htun ◽

Thae Thae Han Htwe ◽

...

Keyword(s):

Exercise Therapy ◽

Platelet Rich Plasma ◽

Corticosteroid Injection ◽

Adhesive Capsulitis ◽

Short Wave ◽

Plasma Injection ◽

Oral Pain ◽

Evaluation Time ◽

Significant Difference ◽

Conventional Physiotherapy

Objective We evaluated the effect of ultrasound (US)-guided injection of platelet-rich plasma (PRP) into the shoulder joint in patients with adhesive capsulitis (AC) and compared its effect with that of conventional physiotherapy (CPT). Methods Sixty-four subjects with AC were included and randomly allocated into two groups, as follows: PRP (n=32; intra-articular [IA] PRP [4 mL] was injected); and CPT (n=32; short wave diathermy and exercise therapy were performed at three sessions/week for 6 weeks). Treatment outcomes evaluated therapeutic effectiveness before and at 1, 3, and 6 weeks after PRP injection and CPT initiation. Results Subjects in both groups showed a significant decrease in the visual analogue scale score for pain and shoulder and hand scores, and they a significant increase in shoulder passive range of motion at all evaluation time points. There was no significant difference in the measured outcomes between the two groups. However, there was less acetaminophen consumption after IA PRP injection compared with that after CPT. Conclusions IA PRP injection is a useful option for treating patients with AC, particularly those who have low therapeutic compliance for exercise therapy or have contraindications for corticosteroid injection or oral pain reduction medication.

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Assessment of Rotator Cuff Partial Tear Treatment with Ultrasound Guided Platelet Rich Plasma Injection

QJM ◽

10.1093/qjmed/hcab106.046 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Hana Hamdy Nassef ◽

Amir Louis Louka ◽

Mohamed Tarek Ali Abdelhamid Khedr

Keyword(s):

Rotator Cuff ◽

Platelet Rich Plasma ◽

Rotator Cuff Tears ◽

Ultrasound Guided ◽

University Hospitals ◽

Partial Tear ◽

Plasma Injection ◽

Partial Tears ◽

Work Assessment ◽

Shoulder Score

Abstract Background Rotator cuff tears are a common orthopedic problem, and often these tears are so-called partial tears of the rotator cuff. A partial tear of the rotator cuff is an area of damage or degeneration to the rotator cuff tendons, where the tear does not go all the way through the tendons Objectives The aim of the work assessment of rotator cuff partial tear treatment with ultrasound guided platelet rich plasma injection. Patients and Methods Single arm interventional study which was conducted in Ain shams university hospitals in the period between March 2020 and October 2020, 10 confirmed cases of rotator cuff partial tear diagnosed by MRI were included in this study. Their ages ranging from 25 to 70 years old. Results Our study showed statistically significant improvements in 10 patients in VAS pain score, constant shoulder score, PENN shoulder score and OXFORD shoulder score. Conclusion The ultrasound-guided PRP injection for rotator cuff partial thickness tears is a safe, cheap, and easily prepared outpatient procedure which showed competitive, promising and wellproved results. PRP has the potential to heal the muscle-tendon unit of the rotator cuff and may be a primary nonsurgical treatment modality for rotator cuff tears.

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