Role of platelet-rich plasma in the treatment of rotator cuff tendinopathy

Table 1 Single or double-arms trials assessing effectiveness of platelet-rich plasma vs placebo injections, dry needling, or exercise

Ref.	Level of evidence	Design	Groups (n)	Injections/dosis	Outcomes measure	Follow-up	Conclusions
Kesikburun et al[54], 2013	I	Ultrasound-guided PRP injections vs saline injections	40 patients PRP (20), placebo (20)	1/5 mL	VAS, WORC, and SPADI	3, 6, 12, 24 wk. 1 yr	PRP is not more effective in improving shoulder quality of life, pain, disability, and range of motion than placebo
Rha et al[57], 2013	I	PRP injections vs dry needling	39 patients. PRP (20), dry needling (20)	1/3 mL	SPADI, passive ROM, global rating scale, ultrasound measurement	24 wk	PRP leads to a progressive reduction in pain and disability compared to dry needling
Scarpone et al[59], 2013	III	Ultrasound guided PRP injection at the lesion and surrounding tendon	18	1/3.5 mL	MRI, VAS and three-item patient satisfaction scale	8, 12, 52 wk	Improvement in MRI, pain and function with PRP
Lee et al[62], 2019	III	PRP injection vs exercise treatment; leukocyte-poor vs leukocyte-rich PRP	60. PRP (27), exercise (33)	1/1.5 mL	ASES, CMS, and NRS	12 wk, 24 wk	PRP is more effective than exercise therapy for the first 3 mo
Kim et al[55], 2019	II	PRP injection vs exercise treatment	30 patients. PRP (15), exercise (15)	1/2 mL	ASES, CMS, and NRS	12 wk, 24 wk	PRP had an advantage over exercise; improvement until 12 wk, slight decrease at 24 wk
Rossi et al[71], 2021	II	Subacromial PRP injections	50 patients	1/5 mL	ASES, CMS, and VAS	1 yr	PRP decreased pain, improved functional outcomes, and resolved sleep disturbances. Return to sports for most athletes
Oudelaar et al[77], 2021	I	NACD + PRP vs NACD + CI	88 patients. NACD + PRP (41), NACD + CI (47)	1/5 mL	VAS, CMS, DASH, OSS, EQ-5D	6 wk, 3 mo, 6 mo, 12 mo, 24 mo	NACD + PRP was worse at the 6-wk follow-up but better at the 6-mo follow-up. Comparable results at 12 and 24 mo

ASES: American Shoulder and Elbow Surgeons score; CMS: Constant Murley Score; CI: Corticosteroid injection; DASH: Disability of Arm-Hand-Shoulder score; PRP: Platelet-rich plasma; ROM: Range of motion; SPADI: Shoulder Pain and Disability Index; SST: Simple Shoulder Test; UCLA: University of California Los Angeles score; VAS: Visual analog scale; WORC: Western Ontario Rotator Cuff; MRI: Magnetic resonance imaging; NACD: Needle Aspiration of Calcific Deposits; OSS: Oxford Shoulder Score.

Table 2 Randomized controlled trials comparing platelet-rich plasma vs corticosteroid injections for rotator cuff tendinopathy

Ref.	Level of evidence	Design	Groups (n)	Dosis/quantity	Outcomes measure	Follow-up	Conclusions
Barreto et al[66], 2019	I	Subacromial PRP injections vs CI	51 patients. PRP (26), CI (25)	1/about 3 mL	DASH, UCLA- SRS, CMS	3mo, 6 mo	No statistically significant differences
Dadgostar et al[63], 2021	I	Ultrasound guided PRP injections vs CI	58 patients. (30) PRP, (28) CI	1/3 mL intra-articular, 3 mL intratendinoeus	VAS, ROM, WORC, DASH, US supraspinatus thickness	3 mo	PRP with similar results to CI
Kwong et al[70], 2021	I	Ultrasound-guided leokocyte-poor PRP injection vs CI	99 patients. PRP (47), CI (52)	1/(3-5) mL intratendineous (non-specific) and the rest at the subacromial space	VAS, ASES score, and WORC	6, 12, 48 wk	The PRP group showed superior improvement in pain and function at short-term follow-up, without benefit at long-term follow-up
Ibrahim et al[68], 2019	I	Ultrasound guided subacromial PRP vs CI	30 patients. PRP (15), CI (15)	1/2 mL	VAS, SDQ, ROM Clnical tests, US findings	8 wk	Both groups showed significant improvement. PRP is safe and can be used for PRCT
Jo et al[78], 2020	I	Ultrasound guided allogenic PRP vs CI	60 patients. PRP (30), CI (30)	1/4 mL	VAS, CMS, ASES, DASH, RC strength, ROM	1, 4, 12, 24 wk	PRP reduced pain and improved overall function at 6 mo. DASH score, overall function, and external rotation were significantly better in the PRP group
Pasin et al[79], 2019	I	PRP vs CI vs exercise	60 patients. PRP (30), CI (30)	1/4 mL	VAS, quick DASH, UCLA SRS, SF-36	3, 8 wk	PRP had better scores than CI and Physical Therapy even in a long time
Sabaah et al[80], 2020	I	Prolotherapy vs CI and PRP	40 patients. PRP (20), CI (20)	2/5 mL	VAS, WORC-Index, ROM and US findings	12 wk	Prolotherapy was superior. PRP improve tendon healing
Sari et al[81], 2020	I	Ultrasound guided PRP vs CI, prolotherapy and lidocaine	60 patients. PRP (30), CI (30)	1/5 mL	VAS, ASES and WORC	3, 12, 24 wk	CI were better at 3 wk. NO difference at 12 wk. PRP had better outcomes at 24 mo
Thepsoparn et al[82], 2021	I	Ultrasound guided leukocyte-poor PRP vs CI	31 patients. PRP (15), CI (16)	1/5 mL	VAS and OSS	4, 24 wk	No difference at 4 wk. PRP had better results at 24 wk for PRCT. No complications

ASES: American Shoulder and Elbow Surgeons score; CMS: Constant Murley Score; CI: Corticosteroid injection; DASH: Disabilities of the Arm, Shoulder and Hand score; PRP: Platelet-rich plasma; ROM: Range of motion; SPADI: Shoulder Pain and Disability Index; SST: Simple Shoulder Test; UCLA: University of California Los Angeles score; UCLA-SRS: University of California Los Angeles Shoulder Rating Score; VAS: Visual analog scale; WORC: Western Ontario Rotator Cuff; MRI: Magnetic resonance imaging; SDQ: Shoulder Disability Questionnaire; PRCT: Partial rotator cuff tears; SF-36: Short Form 36; OSS: Oxford Shoulder Score.