Clinical Question

Are platelet-rich plasma injections beneficial in the nonoperative treatment of rotator cuff disease in adults?

Bottom Line

The review found no evidence that supports any additional benefit of platelet-rich plasma injections compared with various control interventions, including saline placebo, in the non-operative treatment of rotator cuff disease in adults. Exercise therapy was shown to be superior to platelet-rich plasma injections in improving outcomes in the included studies. (Level of Evidence = 1a)

Synopsis

The benefits of platelet-rich plasma injections in the management of various tendinopathies are inconsistent. The investigators searched Medline, Embase, and the Cochrane Library for English-language–only randomized controlled trials that compared platelet-rich plasma injections with control treatments in adults with chronic rotator cuff disease. Two reviewers used a standard evaluation tool to independently analyze individual articles for inclusion criteria and risk of bias. Discrepancies were resolved after consensus discussion with a third reviewer. Five studies (N = 214) met inclusion criteria, with one considered at low risk, three at moderate risk, and one at high risk of bias. Various controls included corticosteroid injection, dry needling, saline solution injection, and formal exercise therapy. At follow-up (range of six to 12 months), no differences occurred between active treatment with platelet-rich plasma injections and any of the control interventions for pain scores, disability measures, or range of motion. In the two studies in which platelet-rich plasma injections alone were used in the treatment group, the control group receiving exercise therapy had superior clinical outcomes.

Study design: Systematic review

Funding source: Unknown/not stated

Setting: Various (meta-analysis)

Reference: Hurley ET, Hannon CP, Pauzenberger L, et al. Nonoperative treatment of rotator cuff disease with platelet-rich plasma: a systematic review of randomized controlled trials. Arthroscopy. 2019;35(5):1584–1591.