scholarly journals Conservative treatment of partial-thickness rotator cuff tears and tendinopathy with platelet-rich plasma: A systematic review and meta-analysis

2021 ◽  
pp. 026921552110119
Author(s):  
Xiao-Na Xiang ◽  
Jie Deng ◽  
Yan Liu ◽  
Xi Yu ◽  
Biao Cheng ◽  
...  
Keyword(s):  
Pain Relief ◽  
Rotator Cuff ◽  
Platelet Rich Plasma ◽  
Meta Analysis ◽  
Rotator Cuff Tears ◽  
Short Term ◽  
Constant Murley Score ◽  
Partial Thickness ◽  
And Function

Objective: To assess the effect of platelet-rich plasma as a conservative therapy in individuals with partial-thickness rotator cuff tears or tendinopathy on pain, and function. Data sources: Embase, MEDLINE, CENTRAL, Web of Science, CINAHL, PEDro, and the grey literature (to 31 March 2021). Methods: Randomized controlled trials in English that reported short-term (6 ± 1 months), or long-term (⩾1 year) outcomes (shoulder pain or function) were conducted. Two independent reviewers screened the literature, completed the assessment of the Cochrane’s risk of bias and extracted the data. Mean difference or standardized mean difference was used for continuous data. Heterogeneity was identified with I2 test. Results: A total of 11 studies were eligible, and nine studies ( n = 629) were included in this meta-analysis, that showed statistically significant short-term effects of platelet-rich plasma on pain relief (MD = −1.56; 95% CI −2.82 to −0.30), Constant-Murley score (MD = 16.48; 95% CI 12.57 to 20.40), and Shoulder Pain and Disability Index (MD = −18.78; 95% CI −36.55 to −1.02). Nonetheless, no long-term effect was observed on pain and function, except Constant-Murley score (MD = 24.30; 95% CI 23.27 to 25.33). The results of minimal important difference reached the minimal clinically important difference, except American Shoulder and Elbow Surgeons. For subgroup analysis, differences of pain relief were statistically significant in platelet-rich plasma-treated groups with double centrifugation, single injection, and post-injection rehabilitation. Conclusion: Our results suggested platelet-rich plasma had positive effects on pain relief and functional improvement for partial-thickness rotator cuff tears and rotator cuff tendinopathy, although the effects may not last for a long time.

scholarly journals Conservative treatment of partial-thickness rotator cuff tears and tendinopathy with platelet-rich plasma: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Xiao-Na Xiang ◽  
Jie Deng ◽  
Yan Liu ◽  
Xi Yu ◽  
Biao Cheng ◽  
...  
Keyword(s):  
Systematic Review ◽  
Rotator Cuff ◽  
Platelet Rich Plasma ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Rotator Cuff Tears ◽  
Short Term ◽  
Partial Thickness ◽  
And Function

AbstractPurposeTo assess the effect of platelet-rich plasma (PRP) as a conservative therapy on individuals with partial-thickness rotator cuff tears (PTRCs) or tendinopathy in terms of pain, and function.MethodsA systematic review and meta-analysis of randomized controlled trials were conducted. Short-term (6±1 months) and long-term (≥1 year) outcomes were analysed, including the visual analogue scale (VAS), Constant-Murley score (CMS), Shoulder Pain and Disability Index (SPADI), as well as American Shoulder and Elbow Surgeons (ASES) score. The weighted mean difference (MD) with 95% confidence interval (CI) was used.ResultsTen studies were eligible in this review, nine studies with 561 patients were included in this meta-analysis. The meta-analysis showed statistically significant differences in the decrease in short-term VAS (MD=-1.56; 95% CI -2.82 to -0.30), and increase in CMS (MD=16.48; 95% CI 12.57 to 20.40), and SPADI (MD=-18.78 95% CI -36.55 to -1.02). Nonetheless, no long-term effect was observed on pain and function, except CMS (MD=24.30). The results of mean important differences (MIDs) reached the minimal clinically important differences, except ASES. For subgroup analysis, short-term VAS scores were decreased in PRP-treated patients with double centrifugation (MD=-1.99), single injection (MD=-0.71) and post-injection rehabilitation (MD=-1.59).ConclusionPRP-treated patients with PTRCs and rotator cuff tendinopathy demonstrated improvements in pain and function, although the effect may not last for a long time. Overall, our results suggest that PRP may have positive clinical outcomes, but limited data, and study heterogeneity hinder firm conclusions.

scholarly journals 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

2019 ◽  
Vol 48 (8) ◽  
pp. 2028-2041 ◽  
Author(s):  
Xiao Chen ◽  
Ian A. Jones ◽  
Ryan Togashi ◽  
Caron Park ◽  
C. Thomas Vangsness
Keyword(s):  
Rotator Cuff ◽  
Functional Outcomes ◽  
Methodological Quality ◽  
Platelet Rich Plasma ◽  
Meta Analysis ◽  
Short Term ◽  
Vas Scores ◽  
Level 1 ◽  
Meta Analyses

Background: Many clinical trials have investigated the use of platelet-rich plasma (PRP) to treat rotator cuff–related abnormalities. Several meta-analyses have been published, but none have focused exclusively on level 1 randomized controlled trials. Purpose: To assess the efficacy of PRP for rotator cuff–related abnormalities and evaluate how specific tendon involvement, the inclusion of leukocytes, and the use of gel/nongel formulations affect pain and functional outcomes. Study Design: Systematic review and meta-analysis. Methods: The literature was screened following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Baseline, short-term, and long-term data were extracted for the Constant score, University of California, Los Angeles (UCLA) score, visual analog scale (VAS) for pain, retear rate, Simple Shoulder Test (SST), and American Shoulder and Elbow Surgeons (ASES) score. The 100-point modified Coleman Methodology Score (CMS) was used to assess methodological quality. Funnel plots and the Egger test were used to screen for publication bias, and sensitivity analysis was performed to evaluate the effect of potential outliers. Results: A total of 18 level 1 studies were included in this review, 17 (1116 patients) of which could be included in quantitative analysis. The mean modified CMS was 79.4 ± 10.39. The Constant scores of patients who received PRP were significantly better short term (weighted mean difference [WMD], 2.89 [95% CI, 0.89-4.90]; P < .01) and long term (WMD, 2.66 [95% CI, 1.13-4.19]; P < .01). The VAS scores were significantly improved short term (WMD, –0.45 [95% CI, –0.75 to −0.15]; P < .01). Sugaya grade IV and V retears in PRP-treated patients were significantly reduced long term (odds ratio [OR], 0.34 [95% CI, 0.20-0.57]; P < .01). In PRP-treated patients with multiple tendons torn, there were reduced odds of retears (OR, 0.28 [95% CI, 0.13-0.60]; P < .01). Patients who received leukocyte-rich PRP had significantly better Constant scores compared with the leukocyte-poor PRP group, but there was no difference in VAS scores. Patients receiving PRP gel reported higher Constant scores compared with the controls, whereas those receiving nongel PRP treatments did not, although there was no difference in VAS scores. Long-term odds of retears were decreased, regardless of leukocyte content (leukocyte-poor PRP: OR, 0.36 [95% CI, 0.16-0.82]; leukocyte-rich PRP: OR, 0.32 [95% CI, 0.16-0.65]; all P < .05) or usage of gel (nongel: OR, 0.42 [95% CI, 0.23-0.76]; gel: OR, 0.17 [95% CI, 0.05-0.51]; all P < .01). Conclusion: Long-term retear rates were significantly decreased in patients with rotator cuff–related abnormalities who received PRP. Significant improvements in PRP-treated patients were noted for multiple functional outcomes, but none reached their respective minimal clinically important differences. Overall, our results suggest that PRP may positively affect clinical outcomes, but limited data, study heterogeneity, and poor methodological quality hinder firm conclusions.

scholarly journals The Efficacy of Platelet-Rich Plasma on Tendon and Ligament Healing: A Systematic Review and Meta-analysis With Bias Assessment

2017 ◽  
Vol 46 (8) ◽  
pp. 2020-2032 ◽  
Author(s):  
Xiao Chen ◽  
Ian A. Jones ◽  
Caron Park ◽  
C. Thomas Vangsness
Keyword(s):  
Rotator Cuff ◽  
Platelet Rich Plasma ◽  
Meta Analysis ◽  
Lateral Epicondylitis ◽  
Ligament Injuries ◽  
Short Term ◽  
Rotator Cuff Injuries ◽  
Meta Analyses

Background: There has been a surge in high-level studies investigating platelet-rich plasma (PRP) for tendon and ligament injuries. A number of meta-analyses have been published, but few studies have focused exclusively on tendon and ligament injuries. Purpose: To perform a meta-analysis assessing the ability of PRP to reduce pain in patients with tendon and ligament injuries. Study Design: Systematic review and meta-analysis. Methods: This study followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A comprehensive search of the literature was carried out in April 2017 using electronic databases PubMed, MEDLINE, and the Cochrane Library. Only level 1 studies were included. Platelet and leukocyte count, injection volume, kit used, participant age/sex, comparator, and activating agent used were recorded. The short-term and long-term efficacy of PRP was assessed using the visual analog scale (VAS) to measure pain intensity. Injury subgroups (rotator cuff, tendinopathy, anterior cruciate ligament, and lateral epicondylitis) were evaluated. Funnel plots and the Egger test were used to screen for publication bias, and sensitivity analysis was performed to evaluate the effect of potential outliers by removing studies one at a time. Results: Thirty-seven articles were included in this review, 21 (1031 participants) of which could be included in the quantitative analysis. The majority of studies published investigated rotator cuff injuries (38.1%) or lateral epicondylitis (38.1%). Seventeen studies (844 participants) reported short-term VAS data, and 14 studies (771 participants) reported long-term VAS data. Overall, long-term follow-up results showed significantly less pain in the PRP group compared with the control group (weighted mean difference [WMD], –0.84; 95% CI, –1.23 to –0.44; P < .01). Patients treated with PRP for rotator cuff injuries (WMD, –0.53; 95% CI, –0.98 to –0.09; P = .02) and lateral epicondylitis (WMD, –1.39; 95% CI, –2.49 to –0.29; P = .01) reported significantly less pain in the long term. Substantial heterogeneity was reported at baseline ( I2 = 72.0%; P < .01), short-term follow-up ( I2 = 72.5%; P < .01), long-term follow-up ( I2 = 76.1%; P < .01), and overall ( I2 = 75.8%; P < .01). The funnel plot appeared to be asymmetric, with some missingness at the lower right portion of the plot suggesting possible publication bias. Conclusion: This review shows that PRP may reduce pain associated with lateral epicondylitis and rotator cuff injuries.

Platelet-Rich Plasma Versus Corticosteroid Injections in the Management of Elbow Epicondylitis and Plantar Fasciitis: An Updated Systematic Review and Meta-analysis

2019 ◽  
Vol 48 (10) ◽  
pp. 2572-2585 ◽  
Author(s):  
Kai Huang ◽  
Grey Giddins ◽  
Li-dong Wu
Keyword(s):  
Systematic Review ◽  
Clinical Efficacy ◽  
Effect Size ◽  
Plantar Fasciitis ◽  
Platelet Rich Plasma ◽  
Meta Analysis ◽  
Medium Effect ◽  
Large Effect Size ◽  
Short Term

Background: Platelet-rich plasma (PRP), as a promising alternative to traditional corticosteroid (CS), is now increasingly used in the treatment of elbow epicondylitis (EE) and plantar fasciitis (PF). To date, however, the synthesis of information on the clinical efficacy of PRP versus CS is limited with divergent conclusions. Purpose: To compare the clinical efficacy of PRP and CS injections in reducing pain and improving function in EE and PF. Study Design: Systematic review and meta-analysis. Methods: Online databases were searched from inception to October 2018 for prospective studies evaluating PRP versus CS injections for EE or PF. Independent reviewers undertook searches, screening, and risk-of-bias appraisals. The primary outcomes of interest were pain and function in both the short term (1-3 months) and the long term (≥6 months). Results: Twenty trials with 1268 participants were included. For EE, PRP provides a statistically and clinically meaningful long-term improvement in pain, with a very large effect size of −1.3 (95% CI, −1.9 to −0.7) when compared with CS, but the evidence level was low. For EE, there was moderate evidence that CS provides a statistically meaningful improvement in pain in the short term, with a medium effect size of 0.56 (95% CI, 0.08-1.03) as compared with PRP; this improvement might not be clinically significant. For PF, there was low evidence that PRP provides a statistically and clinically meaningful long-term improvement in function (American Orthopedic Foot & Ankle Society score), with a very large effect size of 1.94 (95% CI, 0.61-3.28). There were no significant differences between the groups in improvement in function in EE and pain and short-term function in PF, but the quality of the evidence was low. Conclusion: The use of PRP yields statistically and clinically better improvement in long-term pain than does CS in the treatment of EE. The use of PRP yields statistically and clinically better long-term functional improvement than that of CS in the treatment of PF.

Use of Platelet-Rich Plasma for the Improvement of Pain and Function in Rotator Cuff Tears: Letter to the Editor

2020 ◽  
Vol 48 (6) ◽  
pp. NP38-NP39
Author(s):  
Eoghan T. Hurley ◽  
Leo Pauzenberger ◽  
Hannan Mullett ◽  
Laith M. Jazrawi
Keyword(s):  
Rotator Cuff ◽  
Platelet Rich Plasma ◽  
Rotator Cuff Tears ◽  
Letter To The Editor ◽  
And Function

scholarly journals Diagnostic accuracy of MRA and MRI for the bursal-sided partial-thickness rotator cuff tears: a meta-analysis

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Tao Huang ◽  
Jian Liu ◽  
Yupeng Ma ◽  
Dongsheng Zhou ◽  
Liang Chen ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Meta Analysis ◽  
Characteristic Curve ◽  
Mr Arthrography ◽  
Diagnostic Value ◽  
Rotator Cuff Tears ◽  
Cochrane Library ◽  
Predictive Values ◽  
Partial Thickness ◽  
Sensitivity Specificity

Abstract Background Numerous quantitatively studies have focused on the diagnosis of bursal-sided partial-thickness rotator cuff tears (RCTs); however, the accuracy of magnetic resonance imaging (MRI) and MR arthrography (MRA) remains inconclusive. This study was performed systematically to compare the diagnostic value of MRA and MRI for the bursal-sided partial-thickness RCTs. Methods Three electronic databases, PubMed, Embase, and Cochrane Library, were utilized to retrieve articles comparing the diagnostic value of MRA and MRI for detecting bursal-sided partial-thickness RCTs. After screening and diluting out the articles that met the inclusion criteria to be used for statistical analysis, the pooled evaluation indexes include sensitivity, specificity, positive and negative predictive values, diagnostic odds ratio (DOR), and the area under the receiver operating characteristic curve (AUC). Results Twelve studies involving 1740 patients and 1741 shoulders were identified. The pooled sensitivity, specificity, DOR, and AUC of MRA to diagnose bursal-sided partial-thickness RCTs were 0.77 (95% CI, 0.67–0.85), 0.98 (95% CI, 0.95–0.99), 73.01 (95% CI, 35.01–152.26), and 0.88 (95% CI, 0.85–0.91), respectively. The pooled sensitivity, specificity, DOR, and AUC of MRI were 0.77 (95% CI, 0.66–0.86) and 0.96 (95% CI, 0.81–0.99), and 37.12 (95% CI, 8.08–170.64) and 0.82 (95% CI, 0.78–0.85), respectively. Conclusions This meta-analysis reveals that MRA and MRI have similar diagnostic value for the diagnosis of bursal-sided partial-thickness rotator cuff tears.

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