Goulart LT, Matsunaga FT, Belloti JC, Netto NA, Paim TS, Tamaoki MJS. Effectiveness of sub-acromial injections in rotator cuff injuries: A systematic review and meta-analysis. World J Orthop 2025; 16(2): 102856 [DOI: 10.5312/wjo.v16.i2.102856]
Corresponding Author of This Article
Luana Tossolini Goulart, Department of Orthopedics and Trauma, Federal University of São Paulo-Paulista School of Medicine, 740 Botucatu Street, São Paulo 04023-062, Brazil. goulart.luana@unifesp.br
Research Domain of This Article
Orthopedics
Article-Type of This Article
Meta-Analysis
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Feb 18, 2025; 16(2): 102856 Published online Feb 18, 2025. doi: 10.5312/wjo.v16.i2.102856
Effectiveness of sub-acromial injections in rotator cuff injuries: A systematic review and meta-analysis
Luana Tossolini Goulart, Fabio Teruo Matsunaga, Joao Carlos Belloti, Nicola Archetti Netto, Thays Sellan Paim, Marcel Jun Sugawara Tamaoki
Luana Tossolini Goulart, Fabio Teruo Matsunaga, Joao Carlos Belloti, Nicola Archetti Netto, Thays Sellan Paim, Marcel Jun Sugawara Tamaoki, Department of Orthopedics and Trauma, Federal University of São Paulo-Paulista School of Medicine, São Paulo 04023-062, Brazil
Author contributions: Goulart LT and Tamaoki MJS devised the project and collected data in the literature on the content covered; Tamaoki MJS conceived the study and was in charge of overall supervision; Matsunaga FT structured the manuscript according to scientific norms; Goulart LT and Paim TS contributed to the design and wrote the manuscript, evaluated the data, and planned the meta-analyses; Belloti JC and Netto NA reviewed the study proposal and contributed to implementation of the research.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Luana Tossolini Goulart, Department of Orthopedics and Trauma, Federal University of São Paulo-Paulista School of Medicine, 740 Botucatu Street, São Paulo 04023-062, Brazil. goulart.luana@unifesp.br
Received: October 31, 2024 Revised: December 20, 2024 Accepted: January 17, 2025 Published online: February 18, 2025 Processing time: 104 Days and 11.8 Hours
Abstract
BACKGROUND
Sub-acromial injections are a therapeutic option for rotator cuff injuries; however, evidence regarding the most effective drug in this context is unclear, which needs to be investigated.
AIM
To evaluate the effectiveness of various sub-acromial injections for rotator cuff injuries.
METHODS
We conducted a systematic review and pair-wise and network meta-analyses of randomized clinical trials (RCTs) comparing sub-acromial injections for rotator cuff injuries. The interventions evaluated were hyaluronic acid (HA), platelet-rich plasma (PRP), prolotherapy, and corticosteroids. The outcomes of interest were pain and functional improvement, which were evaluated with standardized scores. The Risk of Bias 2 tool and the Grading of Recommendations, Assessment, Development and Evaluation methodology were used to assess data quality.
RESULTS
Twenty RCTs, comprising 1479 participants, were included. In the short term, HA achieved the best outcomes [pain mean difference (MD) = -1.48, 95% confidence interval (CI) -2.37 to -0.59; function MD = 10.18, 95%CI: 4.96-15.41]. In the medium term, HA, PRP, HA + PRP, and corticosteroids were not superior to placebo in improving pain. Based on function, HA + PRP was superior to placebo, corticosteroids, and PRP (MD = 26.72; 95%CI: 8.02-45.41). In the long term, HA, PRP, and corticosteroids were not superior to placebo in reducing pain. However, based on function, HA + PRP, PRP, and HA were superior to placebo, and HA + PRP had the best result (MD = 36.64; 95%CI: 31.66-33.62).
CONCLUSION
HA provides satisfactory short-term results, while HA with PRP demonstrates functional improvement in the medium and long terms. However, no intervention maintained the pain-relief effect on > 3-month follow-up.
Core Tip: This study investigates, through network meta-analyses, the effectiveness of different sub-acromial injections for rotator cuff injuries. The main findings include that hyaluronic acid (HA) offers the best short-term pain relief, while HA combined with platelet-rich plasma shows the most significant functional improvement in the medium and long terms. None of the interventions sustained pain relief beyond three months. These results provide critical insights for optimising therapeutic strategies for rotator cuff injuries.
