Effectiveness of Platelet-Rich Plasma Injection in Rotator Cuff Tendinopathy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Meng-Ting Lin, Kuo-Chang Wei, Chueh-Hung Wu, Meng-Ting Lin, Kuo-Chang Wei, Chueh-Hung Wu

Abstract

Background: To investigate the effectiveness of platelet-rich plasma (PRP) injection among patients with rotator cuff tendinopathy in comparison with sham injection, no injection, or physiotherapy alone.

Methods: From the earliest records to November 1, 2018, all published or unpublished randomized controlled trial (RCTs) comparing PRP injection with a control group (sham injection, no injection, or physiotherapy alone) in patients with rotator cuff tendinopathy were included. Eligible trials were included from the search results of electronic databases including PubMed, EMBASE, Scopus, The Cochrane Library, as well as the bibliographies of relevant trials. Five RCTs were enrolled in our meta-analysis. Two authors independently assessed the quality of RCTs with the Cochrane risk of bias tool. We designated pain reduction as the primary outcome and functional improvement as the secondary outcome. Standardized mean difference (SMD) was applied for random-effect meta-analysis.

Results: In the short term (3-6 weeks) and medium term (12 weeks), the effectiveness of PRP injection and control group was indistinguishable in terms of both outcomes (pain reduction and functional improvement). Nevertheless, PRP injection led to significant long-term (>24 weeks) pain relief (SMD: 0.42, 95% confidence interval (CI): 0.12-0.72, without heterogeneity). For functional improvement in the long term, PRP injection was not more effective than the control group (SMD: 1.20, 95% CI: -0.20-2.59, with heterogeneity).

Conclusions: PRP injection may provide benefit over the control group (sham injection, no injection, or physiotherapy alone) in reducing pain at long-term follow-up for patients with rotator cuff tendinopathy.

Keywords: injections; platelet-rich plasma; rotator cuff; tendinopathy.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
A flow diagram of study inclusions. PRP, platelet-rich plasma.
Figure 2
Figure 2
Risk of bias summary (A) and graph (B). Green, low risk of bias; red, high risk of bias; yellow, unclear risk of bias.
Figure 3
Figure 3
Forest plots of meta-analysis after sensitivity analysis: comparison between PRP injection and the control group in pain reduction (A) and functional improvement (B) at the short term (3–6 weeks), the medium term (12 weeks), and the long term (over 24 weeks). Abbreviation: PRP, platelet-rich plasma.
Figure 4
Figure 4
Funnel plots showing publication bias for pain reduction (left) and functional improvement (right) at the short term (A, 3–6 weeks), the medium term (B, 12 weeks), and the long term (C, over 24 weeks).
Figure 5
Figure 5
Forest plots of subgroup analysis: comparison between PRP and control groups including sham injection, dry needing, and physiotherapy in pain reduction (A) and functional improvement (B) at the short term (3–6 weeks), the medium term(12 weeks), and the long term(over 24 weeks). Abbreviation: PRP, platelet-rich plasma.

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Source: PubMed

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