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Studies

Platelet Rich Plasma vs. Cortisone Injection for Partial Rotator Cuff Tears

A recent study published in the European Journal of Orthopaedic Surgery and Traumatology (Aug 20, 2016) compared cortisone injections to Platelet Rich Plasma injections for patients with a painful partial rotator cuff tear. This was a prospective, randomized controlled study that enrolled 40 patients with a symptomatic (painful) rotator cuff tear. Patients were evaluated prior the injection and at specific time intervals (6 weeks, 3 months, and 6 months) following the injection. Standardized outcome measures including the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), the Constant-Murley Score (CMS), Simple Shoulder Test (SST) and Visual Analog Scale (VAS) were utilized.

The results of the study showed that both the cortisone injection group and PRP group both received significant clinical improvement following an injection. The PRP group had superior results that were statistically significant at 12 weeks with all outcome measures. At 6 months after the injection, there was no statistical difference between the groups.

The authors of this study concluded that subacromial PRP injection should be considered a good alternative to cortisone injections especially in light of the potential complications associated with corticosteroids.

The results of this study mirror findings from a previous investigation of 50 patients by von Wehren et al (Knee Surg Sports Trauma Arthro May 2015). The theory behind the results, relates to some evidence that the platelets may help provide revascularization to the injured rotator cuff tendon.

More evidence is needed to fully support the use of PRP for the indication of a symptomatic partial rotator cuff tear. The current evidence does suggest a viable alternative to corticosteroid injections for short term relief with a lower risk of complications.

Platelet-Rich Plasma (PRP) Injections for the treatment of knee osteoarthritis

A new study published in the American Journal of Sports Medicine looked at the use of Platelet Rich Plasma (PRP) injections for osteoarthritis of the knee both from a safety and efficacy standpoint.

This was a small study consisting of 30 patients who received an intra-articular PRP injection in the knee consecutively for 3 weeks. Specifically, 3 to 8 mL of PRP was injected. Patients in the control group received 3 intra-articular injections of saline. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score was used to assess outcome.

The results showed that those who received the PRP injections had a 78% improvement from baseline whereas the controls only had a 7% improvement at 12 months. WOMAC scores improved to a greater degree in the PRP group than controls starting at 2 weeks. This effect lasted throughout the duration of the study.

Overall there were no adverse events associated with the PRP injections. As this study was sanctioned by the Food and Drug Administration (FDA), the small study size was mandated to evaluate for safety. The results of this study support prior observations by Duymus et al (Knee Surgery Sports Traumatology Arthroscopy 2016) and Kavadar et al (Journal of Physical Therapy Science 2015). A recent systematic review by Meheux et al (Arthroscopy 2016) which included 6 published studies with a minimum of 6 months of follow-up also reported significant clinical efficacy for PRP injections in the treatment of knee osteoarthritis up to 12 months.

References:

Smith P. Intra-articular autologous conditioned plasma injections provide safe and efficacious treatment for knee osteoarthritis: an FDA-sanctioned, randomized, double-blind, placebo-controlled trial. American Journal of Sports Medicine. 2016. Apr 44(4): 884-891.

Duymus TM et al. Choice of intra-articular injection in treatment of knee osteoarthritis: platelet-rich plasma, hyaluronic acid or ozone options. Knee Surgery, Sports Traumatology, Arthroscopy. 2016. Apr 7.

Kavadar G. et al. Effectieness of platelet-rich plasma in the treatment of moderate knee osteoarthritis: a randomized prospective study. Journal of Physical Therapy Science. 2015: Dec 27(12): 3863-3867.

Meheux CJ et al. Efficacy of Intra-articular Platelet-Rich Plasma Injections in Knee Osteoarthritis: A systematic review. Arthroscopy. 2016. Mar 32(3): 495-505.

Prolotherapy for Rotator Cuff Disease

In follow-up to a previous blog from October 2015 regarding prolotherapy in the treatment of rotator cuff disorders, another study was recently published showing positive results.

Lee et al (Arch Phys Med Rehab 2015) performed a retrospective case-control study evaluating prolotherapy in the treatment of rotator cuff disease. In this study, 63 patients received prolotherapy, consisting of 16.5% dextrose solution and 63 patients received conservative treatment. The outcome measures of the study included the visual analog scale (VAS), average shoulder pain score for the past week, Shoulder Pain and Disability Index Score, active range of shoulder motion, isometric shoulder strength, and medication (analgesic) use per day. At one year of follow-up, patients in the prolotherapy group received an average of 4.8 ± 1.3 injections and had significant improvements in VAS, SPADI scores, isometric strength, and active range of motion when compared with the control group.

As the authors pointed out, prolotherapy appeared to be effective in the treatment of chronic rotator cuff disease (duration of at least 3 months), however, as this study was non-randomized and retrospective in nature, the results must be interpreted with caution.

This is the second recent study to conclude that dextrose prolotherapy is efficacious in the treatment of rotator cuff disease. Bertrand et al (Arch Phys Med Rehab 2016) showed that injections of hypertonic dextrose resulted in superior long term pain improvement and patient satisfaction for those with painful rotator cuff tendinopathy. As with many prolotherapy investigations, it is often difficult to compare studies as the specific diagnosis from one study to another often differs as does the treatment protocol and outcome measures. Nonetheless, prolotherapy does appear to be beneficial for a number of musculoskeletal condition with no reported adverse events.