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Pitsilos C, Karachrysafi S, Fragou A, Gigis I, Papadopoulos P, Chalidis B. The Biological Effect of Platelet-Rich Plasma on Rotator Cuff Tears: A Prospective Randomized In Vivo Study. Int J Mol Sci 2024; 25:7957. [PMID: 39063199 PMCID: PMC11277466 DOI: 10.3390/ijms25147957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 07/15/2024] [Accepted: 07/18/2024] [Indexed: 07/28/2024] Open
Abstract
The positive effect of platelet-rich plasma (PRP) on tendon metabolism has been extensively investigated and proven in vitro. Additionally, in vivo animal studies have correlated the application of PRP with the enhancement of tenocyte anabolic activity in the setting of tendon degeneration. However, less is known about its in vivo effect on human tendon biology. The purpose of the current prospective randomized comparative study was to evaluate the effect of PRP on torn human supraspinatus tendon. Twenty consecutive eligible patients with painful and magnetic resonance imaging (MRI)-confirmed degenerative supraspinatus tendon tears were randomized in a one-to-one ratio into two groups. The patients in the experimental group (n = 10) underwent an ultrasound-guided autologous PRP injection in the subacromial space 6 weeks before the scheduled operation. In the control group (n = 10), no injection was made prior to surgery. Supraspinatus tendon specimens were harvested from the lateral end of the torn tendon during shoulder arthroscopy and were evaluated under optical and electron microscopy. In the control group, a mixed cell population of oval and rounded tenocytes within disorganized collagen and sites of accumulated inflammatory cells was detected. In contrast, the experimental group yielded abundant oval-shaped cells with multiple cytoplasmic processes within mainly parallel collagen fibers and less marked inflammation, simulating the intact tendon structure. These findings indicate that PRP can induce microscopic changes in the ruptured tendon by stimulating the healing process and can facilitate a more effective recovery.
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Affiliation(s)
- Charalampos Pitsilos
- 2nd Orthopaedic Department, Aristotle University of Thessaloniki, 54635 Thessaloniki, Greece; (C.P.); (I.G.); (P.P.)
| | - Sofia Karachrysafi
- Research Team “Histologistas”, Interinstitutional Postgraduate Program “Health and Environmental Factors”, Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
- Laboratory of Histology-Embryology, Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Aikaterini Fragou
- Laboratory of Biological Chemistry, Medical Department, School of Health Science, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Ioannis Gigis
- 2nd Orthopaedic Department, Aristotle University of Thessaloniki, 54635 Thessaloniki, Greece; (C.P.); (I.G.); (P.P.)
| | - Pericles Papadopoulos
- 2nd Orthopaedic Department, Aristotle University of Thessaloniki, 54635 Thessaloniki, Greece; (C.P.); (I.G.); (P.P.)
| | - Byron Chalidis
- 1st Orthopaedic Department, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
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Pintaric K, Salapura V, Snoj Z, Vovk A, Mijovski MB, Vidmar J. Assessment of short-term effect of platelet-rich plasma treatment of tendinosis using texture analysis of ultrasound images. Radiol Oncol 2023; 57:465-472. [PMID: 38038412 PMCID: PMC10690750 DOI: 10.2478/raon-2023-0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/06/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Computer-aided diagnosis (i.e., texture analyses) tools are becoming increasingly beneficial methods to monitor subtle tissue changes. The aim of this pilot study was to investigate short-term effect of platelet rich plasma (PRP) treatment in supraspinatus and common extensor of the forearm tendinosis by using texture analysis of ultrasound (US) images as well as by clinical questionnaires. PATIENTS AND METHODS Thirteen patients (7 male and 6 female, age 36-60 years, mean age 51.2 ± 5.2) were followed after US guided PRP treatment for tendinosis of two tendons (9 patients with lateral epicondylitis and 4 with supraspinatus tendinosis). Clinical and US assessment was performed prior to as well as 3 months after PRP treatment with validated clinical questionnaires. Tissue response in tendons was assessed by using gray level run length matrix method (GLRLM) of US images. RESULTS All patients improved of tendinosis symptoms after PRP treatment according to clinical questionnaires. Almost all GLRLM features were statistically improved 3 months after PRP treatment. GLRLM-long run high gray level emphasis (LRLGLE) revealed the best moderate positive and statistically significant correlation after PRP (r = 0.4373, p = 0.0255), followed by GLRLM-low gray level run emphasis (LGLRE) (r = 0.3877, p = 0.05). CONCLUSIONS Texture analysis of tendinosis US images was a useful quantitative method for the assessment of tendon remodeling after minimally invasive PRP treatment. GLRLM features have the potential to become useful imaging biomarkers to monitor spatial and time limited tissue response after PRP, however larger studies with similar protocols are needed.
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Affiliation(s)
- Karlo Pintaric
- Institute of Radiology, University Medical Center Ljubljana, Ljubljana, Slovenia
- Department of Radiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Vladka Salapura
- Institute of Radiology, University Medical Center Ljubljana, Ljubljana, Slovenia
- Department of Radiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ziga Snoj
- Institute of Radiology, University Medical Center Ljubljana, Ljubljana, Slovenia
- Department of Radiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Andrej Vovk
- Center of Clinical Physiology, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Mojca Bozic Mijovski
- Laboratory for Haemostasis and Atherothrombosis, University Medical Center, Ljubljana, Slovenia
- Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
| | - Jernej Vidmar
- Institute of Radiology, University Medical Center Ljubljana, Ljubljana, Slovenia
- Institute of Physiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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尹 正, 陈 志, 尹 妮, 朱 弈, 张 必, 周 田, 谭 洪, 徐 永. [Progress and prospect of biological treatment for rotator cuff injury repair]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2023; 37:1169-1176. [PMID: 37718433 PMCID: PMC10505641 DOI: 10.7507/1002-1892.202303122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/09/2023] [Indexed: 09/19/2023]
Abstract
Objective To review the research progress in biotherapy of rotator cuff injury in recent years, in order to provide help for clinical decision-making of rotator cuff injury treatment. Methods The literature related to biotherapy of rotator cuff injury at home and abroad in recent years was widely reviewed, and the mechanism and efficacy of biotherapy for rotator cuff injury were summarized from the aspects of platelet-rich plasma (PRP), growth factors, stem cells, and exosomes. Results In order to relieve patients' pain, improve upper limb function, and improve quality of life, the treatment of rotator cuff injury experienced an important change from conservative treatment to open surgery to arthroscopic rotator cuff repair. Arthroscopic rotator cuff repair plus a variety of biotherapy methods have become the mainstream of clinical treatment. All kinds of biotherapy methods have ideal mid- and long-term effectiveness in the repair of rotator cuff injury. The biotherapy method to promote the healing of rotator cuff injury is controversial and needs to be further studied. Conclusion All kinds of biotherapy methods show a good effect on the repair of rotator cuff injury. It will be an important research direction to further develop new biotherapy technology and verify its effectiveness.
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Affiliation(s)
- 正勃 尹
- 昆明医科大学研究生院(昆明 650500)Graduate School of Kunming Medical University, Kunming Yunnan, 650500, P. R. China
| | - 志安 陈
- 昆明医科大学研究生院(昆明 650500)Graduate School of Kunming Medical University, Kunming Yunnan, 650500, P. R. China
| | - 妮 尹
- 昆明医科大学研究生院(昆明 650500)Graduate School of Kunming Medical University, Kunming Yunnan, 650500, P. R. China
| | - 弈霏 朱
- 昆明医科大学研究生院(昆明 650500)Graduate School of Kunming Medical University, Kunming Yunnan, 650500, P. R. China
| | - 必欢 张
- 昆明医科大学研究生院(昆明 650500)Graduate School of Kunming Medical University, Kunming Yunnan, 650500, P. R. China
| | - 田华 周
- 昆明医科大学研究生院(昆明 650500)Graduate School of Kunming Medical University, Kunming Yunnan, 650500, P. R. China
| | - 洪波 谭
- 昆明医科大学研究生院(昆明 650500)Graduate School of Kunming Medical University, Kunming Yunnan, 650500, P. R. China
| | - 永清 徐
- 昆明医科大学研究生院(昆明 650500)Graduate School of Kunming Medical University, Kunming Yunnan, 650500, P. R. China
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Longo UG, Lalli A, Medina G, Maffulli N. Conservative Management of Partial Thickness Rotator Cuff Tears: A Systematic Review. Sports Med Arthrosc Rev 2023; 31:80-87. [PMID: 37976129 DOI: 10.1097/jsa.0000000000000372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
BACKGROUND Conservative management has emerged as an attractive option for partial thickness rotator cuff tears (PT-RCTs). A single algorithmic treatment strategy for patients with symptomatic PT-RCT has not yet been developed. This systematic review aims to ascertain whether a conservative approach to PT-RCTs yields positive results in terms of clinical outcomes and functional recovery. METHODS This is a systematic review of the literature on patients with PT-RCTs receiving conservative treatment with physiotherapy, platelet-rich plasma (PRP) injections, collagen injections, hyaluronic acid (HA) injections, or corticosteroids injections coupled with polydeoxyribonucleotide (PDRN). Outcomes such as the Visual Analog Scale (VAS) for pain, American Shoulder and Elbow Surgeons and Constant-Murley Score evaluations, as well as the Shoulder Pain and Disability Index and Euro Quality of Life-5D questionnaires were reported following a conservative approach. RESULTS Eleven studies were included. Six articles explored the outcomes of patients with PT-RCT treated with PRP injections. Significant improvements in VAS for pain were observed. Two studies examined collagen injections and reported variations in VAS for pain and Constant-Murley Score. Sodium hyaluronate and HA injections were studied in two other articles, showing notable improvements in American Shoulder and Elbow Surgeons scores. Corticosteroid and PDRN injections also displayed favorable outcomes. In addition, physical therapy protocols demonstrated improvements in VAS for pain and strength, particularly with eccentric rehabilitation. CONCLUSIONS Conservative management of PT-RCTs, involving physical therapy, PRP injections, collagen injections, corticosteroid injections, HA injections, and PDRN in jections, demonstrates favorable clinical outcomes. In addition, favorable results are observed in terms of decreased tear width and improved strength recovery, at least during a short-term follow-up. Unfortunately, long-term insight into the structural integrity of conservatively treated rotator cuff tendons following a partial injury has not been thoroughly evaluated yet. STUDY DESIGN LEVELS OF EVIDENCE Level IV-systematic review.
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Affiliation(s)
- Umile Giuseppe Longo
- Fondazione Policlinico Universitario Campus-Biomedico
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma
| | - Alberto Lalli
- Fondazione Policlinico Universitario Campus-Biomedico
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma
| | - Giovanna Medina
- Department of Orthopedic Surgery-Sports Medicine Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, School of Medicine and Surgery, University of Salerno, Salerno, Italy
- Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, London, UK
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Rossi LA, Piuzzi N, Tanoira I, Brandariz R, Huespe I, Ranalletta M. Subacromial Platelet-Rich Plasma Injections Produce Significantly Worse Improvement in Functional Outcomes in Patients With Partial Supraspinatus Tears Than in Patients With Isolated Tendinopathy. Arthroscopy 2023; 39:2000-2008. [PMID: 37001744 DOI: 10.1016/j.arthro.2023.03.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 03/05/2023] [Accepted: 03/09/2023] [Indexed: 04/23/2023]
Abstract
PURPOSE To compare the effect of subacromial leukocyte-rich platelet-rich plasma (PRP) injections in patients with isolated rotator cuff tendinopathy (RCT) and those with partial-thickness rotator cuff tears (PTRCTs) based on functional outcomes, pain improvement, sleep disturbances, and return to sports. METHODS Between November 2019 and March 2021, 150 patients underwent PRP injections at our institution for refractory rotator cuff tendinopathy and partial rotator cuff tears (105 RCTs and 45 PTRCTs). The American Shoulder and Elbow Surgeons (ASES) score, the visual analog scale (VAS) for pain, the Single Assessment Numeric Evaluation (SANE) and The Pittsburgh Sleep Quality Index were evaluated at 2-, 6-, and 12-month follow-up. Return to sports was also evaluated. An ultrasound examination was performed to evaluate structural outcomes 12 months after the injection. RESULTS The mean age was 36.6 years (±9.08). Overall, the ASES, VAS, SANE, and Pittsburgh scores showed statistical improvement after the injection (P < .01). Specifically, the improvement in the ASES score, which was the primary outcome measure was significantly greater in the group without tears than in the group with PTRCTs at all follow-up times. Moreover, 94% of the patients in the isolated RCT group and 49% in the PTRCTs group achieved a substantial clinical benefit at 12 months follow-up. Ten out of the 50 patients (20%) who received PRP injections due to a partial RC tear underwent surgery due to the lack of clinical improvement. CONCLUSIONS Subacromial PRP injections produced a significant improvement in shoulder function, pain, and sleep disturbances in most patients with RCT refractory to conservative treatment that was maintained at the 12-month follow-up. Moreover, most patients returned to sports at the same level prior to injury. However, improvement in symptoms and functional outcomes was significantly worse in patients who had a PTRCT compared with patients who had an isolated tendinopathy. LEVEL OF EVIDENCE Level II, prospective cohort study.
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Affiliation(s)
- Luciano A Rossi
- Department of Orthopedics and Traumatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - Nicolás Piuzzi
- Department of Orthopedics and Traumatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ignacio Tanoira
- Department of Orthopedics and Traumatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Rodrigo Brandariz
- Department of Orthopedics and Traumatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ivan Huespe
- Department of Internal Medicine, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Maximiliano Ranalletta
- Department of Orthopedics and Traumatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Abdalla AA, Pendegrass CJ. Biological approaches to the repair and regeneration of the rotator cuff tendon-bone enthesis: a literature review. BIOMATERIALS TRANSLATIONAL 2023; 4:85-103. [PMID: 38283917 PMCID: PMC10817785 DOI: 10.12336/biomatertransl.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/15/2023] [Accepted: 05/05/2023] [Indexed: 01/30/2024]
Abstract
Entheses are highly specialised organs connecting ligaments and tendons to bones, facilitating force transmission, and providing mechanical strengths to absorb forces encountered. Two types of entheses, fibrocartilaginous and fibrous, exist in interfaces. The gradual fibrocartilaginous type is in rotator cuff tendons and is more frequently injured due to the poor healing capacity that leads to loss of the original structural and biomechanical properties and is attributed to the high prevalence of retears. Fluctuating methodologies and outcomes of biological approaches are challenges to overcome for them to be routinely used in clinics. Therefore, stratifying the existing literature according to different categories (chronicity, extent of tear, and studied population) would effectively guide repair approaches. This literature review supports tissue engineering approaches to promote rotator cuff enthesis healing employing cells, growth factors, and scaffolds period. Outcomes suggest its promising role in animal studies as well as some clinical trials and that combination therapies are more beneficial than individualized ones. It then highlights the importance of tailoring interventions according to the tear extent, chronicity, and the population being treated. Contributing factors such as loading, deficiencies, and lifestyle habits should also be taken into consideration. Optimum results can be achieved if biological, mechanical, and environmental factors are approached. It is challenging to determine whether variations are due to the interventions themselves, the animal models, loading regimen, materials, or tear mechanisms. Future research should focus on tailoring interventions for different categories to formulate protocols, which would best guide regenerative medicine decision making.
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Affiliation(s)
- Ahlam A. Abdalla
- Institute of Sport, Exercise and Health (ISEH), Division of Surgery & Interventional Sciences, University College London, London, UK
| | - Catherine J. Pendegrass
- Department of Orthopaedics & Musculoskeletal Science, Division of Surgery & Interventional Sciences, University College London, Brockley Hill, Stanmore, UK
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de Castro RLB, Antonio BP, Giovannetti GA, Annichino-Bizzacchi JM. Total Healing of a Partial Rupture of the Supraspinatus Tendon Using Barbotage Technique Associated with Platelet-Rich Plasma: A Randomized, Controlled, and Double-Blind Clinical Trial. Biomedicines 2023; 11:1849. [PMID: 37509489 PMCID: PMC10376779 DOI: 10.3390/biomedicines11071849] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 06/16/2023] [Accepted: 06/16/2023] [Indexed: 07/30/2023] Open
Abstract
The prevalence of partial rotator cuff tears (PRCTs) is high in the general population. Our hypothesis is that barbotage, when associated with platelet-rich plasma (PRP), is an effective method for healing these tears. The aim of this study was to compare the effects of barbotage with or without PRP on the healing of partial supraspinatus tendon tears (PSTTs). This study assessed the Western Ontario Rotator Cuff Index score and ultrasound (US) images at 6 weeks and 6 months after treatment. Patients in both groups showed clinical improvement, with no significant difference in scores at 6 weeks. However, at 6 months, the PRP group exhibited significant improvement (p = 0.019). Both groups experienced a reduction in ST tear size, but the PRP group demonstrated a significant enhancement at 6 weeks and 6 months. In conclusion, the US-guided barbotage technique, whether associated with PRP or saline solution, proved to be an effective treatment for clinical improvement and reduction in the size of PSTT. Better clinical improvement results were observed with PRP at 6 months. The combination of PRP with barbotage was superior in reducing the size of the ST tear at both 6 weeks and 6 months, resulting in complete healing in 79.3% of the tears.
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Affiliation(s)
- Renato Luiz Bevilacqua de Castro
- Hematology and Hemotherapy Center, University of Campinas, Cidade Universitária, Rua Carlos Chagas 480, Campinas 13083-878, São Paulo, Brazil
- Center for Tissue Regeneration Studies, Avenida Barão de Itapura 3378, Taquaral, Campinas 13070-300, São Paulo, Brazil
| | - Breno Pazinatto Antonio
- Hematology and Hemotherapy Center, University of Campinas, Cidade Universitária, Rua Carlos Chagas 480, Campinas 13083-878, São Paulo, Brazil
- Center for Tissue Regeneration Studies, Avenida Barão de Itapura 3378, Taquaral, Campinas 13070-300, São Paulo, Brazil
| | - Gustavo Atra Giovannetti
- Center for Tissue Regeneration Studies, Avenida Barão de Itapura 3378, Taquaral, Campinas 13070-300, São Paulo, Brazil
| | - Joyce Maria Annichino-Bizzacchi
- Hematology and Hemotherapy Center, University of Campinas, Cidade Universitária, Rua Carlos Chagas 480, Campinas 13083-878, São Paulo, Brazil
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Jo S, Chan Kye Y, Lee J, Jung E, Kang M, Kim B, Kim D, Park B. The effect of shoulder muscle succinylcholine injection on the foreleg raising power: Sion's local paralysis. Heliyon 2023; 9:e14468. [PMID: 37035370 PMCID: PMC10073639 DOI: 10.1016/j.heliyon.2023.e14468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 02/28/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023] Open
Abstract
Objective We examined the change in foreleg raising power after Sion's local paralysis (SLP) with succinylcholine in the shoulder muscle. Methods A randomized, double blind, placebo-controlled, porcine study was designed and performed at a research institution. Ten male Korean native pigs were randomized into an intervention group (n = 5) and a control group (n = 5). The injection points were in the middle of the left trapezius muscle and the middle of the left deltoid muscle. The control group received 2 ml normal saline (NS), 1 ml injected in each point. The intervention group received 0.4 mg/kg succinylcholine diluted to 2 ml in NS, and 1 ml was injected in each point. To represent the foreleg raising power, the height of the left forelegs from baseline (experiment table) was measured. We measured the foreleg height and oxygen saturation at -4, -2, 0, +2, +4, +6, +8, +10, +20, +30, and +60 min. Results After SLP, foreleg height immediately declined in the intervention group. It recovered slightly for a few minutes and declined from 4 to 8 min. In the control group, foreleg height was relatively similar throughout the study period. A repeated-measure analysis of variance revealed a significant group × time interaction (F10,80 = 2.37, P = 0.017), a significant main effect for group (F1,8 = 6.25, P = 0.037), and a significant main effect for time (F10,80 = 4.41, P < 0.001). Post hoc analysis demonstrated that the intervention group showed significantly less foreleg raising power than the control group at 0, 4, 6, 8, 20, and 30 min (P < 0.05). Conclusions Compared with the control group, the foreleg raising power in the intervention group immediately decreased significantly and persisted for a period after SLP, without hypoxia, in a pig model.
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Shankar DS, Mojica ES, Colasanti CA, Blaeser AM, Ortega PF, Gonzalez-Lomas G, Jazrawi LM. Factors impacting time to total shoulder arthroplasty among patients with primary glenohumeral osteoarthritis and rotator cuff arthropathy managed conservatively with corticosteroid injections. Clin Shoulder Elb 2023; 26:32-40. [PMID: 36919505 PMCID: PMC10030987 DOI: 10.5397/cise.2022.01130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 12/25/2022] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND The purpose of this study was to identify predictors of the time from initial presentation to total shoulder arthroplasty (TSA) in patients with primary glenohumeral osteoarthritis (OA) and rotator cuff (RTC) arthropathy who were conservatively managed with corticosteroid injections. METHODS We conducted a retrospective cohort study of patients who underwent TSA from 2010 to 2021. Kaplan-Meier survival analysis was used to estimate median time to TSA for primary OA and RTC arthropathy patients. The Cox proportional hazards model was used to identify significant predictors of time to TSA and to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). Statistical significance was set at P<0.05. RESULTS The cohort included 160 patients with primary OA and 92 with RTC arthropathy. In the primary OA group, median time to TSA was 15 months. Significant predictors of shorter time to TSA were older age at presentation (HR, 1.02; 95% CI, 1.00-1.04; P=0.03) and presence of moderate or severe acromioclavicular joint arthritis (HR, 1.45; 95% CI, 1.05-2.01; P=0.03). In the RTC arthropathy group, median time to TSA was 14 months, and increased number of corticosteroid injections was associated with longer time to TSA (HR, 0.87; 95% CI, 0.80-0.95; P=0.003). CONCLUSIONS There are distinct prognostic factors for progression to TSA between primary OA patients and RTC arthropathy patients managed with corticosteroid injections. Multiple corticosteroid injections are associated with delayed time to TSA in RTC arthropathy patients.
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Affiliation(s)
- Dhruv S Shankar
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Edward S Mojica
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | | | - Anna M Blaeser
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Paola F Ortega
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | | | - Laith M Jazrawi
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
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Xu P. Effects of ultrasound-guided platelet-rich plasma combined with sodium hyaluronate on shoulder function recovery, pain degree and mental health of patients with rotator cuff injury. Biotechnol Genet Eng Rev 2023:1-20. [PMID: 36841938 DOI: 10.1080/02648725.2023.2183312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 02/13/2023] [Indexed: 02/27/2023]
Abstract
Rotator cuff injury is a common condition that affects the shoulder and is characterized by damage to the tendons and muscles in the shoulder area. This type of injury can lead to decreased shoulder function, pain, and decreased quality of life for those affected. As such, finding effective treatments for rotator cuff injury is important for improving patient outcomes and reducing the impact of this condition on patients and society. The purpose of this study was to evaluate the effectiveness of SH (Sodium Hyaluronate) and PRP (Platelet-Rich Plasma) in treating rotator cuff injuries in the shoulder. Patients who were diagnosed with Rotator Cuff Injury (RCI) and received treatment at the hospital were selected as the study subjects and divided into four groups. Various treatments were given to patients in each group. Two-way ANOVA and Mann-Whitney tests were used to analyze the results. The study found that patients who received ultrasound-guided platelet-rich plasma combined with sodium hyaluronate had significantly higher shoulder function recovery rates and better quality of life compared to the other groups. They also reported significantly lower pain scores compared to the other groups. The results suggest that ultrasound-guided platelet-rich plasma combined with sodium hyaluronate can effectively improve the shoulder function of patients with rotator cuff injury, reducing pain and improving their overall well-being. This has implications for improving patient outcomes and reducing the impact of rotator cuff injury on patients and society by providing a promising treatment option for this common condition.
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Affiliation(s)
- Peng Xu
- Department of Articular Orthopaedics, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Suzhou, China
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Escaloni J, Mazloomdoost D, Young I. Novel Orthobiologic Preparation and Regenerative Rehabilitation of a Complex Shoulder Injury in a Competitive Adolescent Female Athlete. Int J Sports Phys Ther 2023; 18:240-252. [PMID: 36793563 PMCID: PMC9897030 DOI: 10.26603/001c.68143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 12/23/2022] [Indexed: 02/05/2023] Open
Abstract
Background Platelet-rich plasma (PRP) and prolotherapy have resulted in promising outcomes in patients with various types of shoulder injuries. However, there is a lack of preliminary evidence supporting preparation of PRP production, timely application of these therapies and regenerative rehabilitation protocols. The purpose of this case report is to describe the distinct method including orthobiologic preparation, tissue-specific treatment and regenerative rehabilitation of an athlete with a complex shoulder injury. Case Presentation A 15y/o competitive female wrestler with a complex shoulder injury presented to the clinic after unsuccessful conservative rehabilitation. Unique methods were incorporated to optimize PRP production, specific tissue healing and regenerative rehabilitation. Multiple injuries required different orthobiologic interventions at different time frames, in order to promote optimal healing and stability of the shoulder. Outcomes The described interventions resulted in successful outcomes including pain, disability, full return to sport, and regenerative tissue healing confirmed with diagnostic imaging. Level of Evidence 5.
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Affiliation(s)
- James Escaloni
- American Academy of Manipulative Therapy
- Wellward Regenerative Medicine
| | | | - Ian Young
- American Academy of Manipulative Therapy
- Tybee Wellness & Osteopractic
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Collagen and platelet-rich plasma in partial-thickness rotator cuff injuries. Friends or only indifferent neighbours? Randomised controlled trial. BMC Musculoskelet Disord 2022; 23:1109. [PMID: 36536333 PMCID: PMC9764482 DOI: 10.1186/s12891-022-06089-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Partial-thickness rotator cuff injuries (PTRCI) are the sum of degenerative, overload, and microtrauma processes. An external supply of collagen and platelet-rich plasma (PRP) could potentially counteract the deterioration of degenerative tendinopathy. This study aimed to compare the effectiveness of collagen with PRP, PRP alone, and collagen alone in the treatment of PTRCI. METHODS Ninety patients with PTRCI were randomised and treated with ultrasound-guided injections into the shoulder bursa every consecutive week: Group A - collagen with PRP (n = 30), Group B - collagen alone (n = 30), and Group C - PRP alone (n = 30). Primary outcomes were pain intensity measured in control points on a numeric rating scale (NRS), QuickDash, and EQ-5D-5L questionnaires at the initial assessment (IA) and control assessments after 6 (T1), 12 (T2), and 24 (T3) weeks, respectively. RESULTS No statistical differences were found between groups in primary outcomes, although there was a trend towards improvement in Groups A and C (opposite to Group B) between T2 and T3. The following parameters were also observed: rotator cuff discontinuity (n = 3, one case in each group) and rotator cuff regeneration (n = 22 in Group A, n = 20 in Group B, and n = 23 in Group C). CONCLUSIONS Combined therapy of collagen and PRP in PTRCI presents similar effectiveness to monotherapies with collagen or PRP. TRIAL REGISTRATION The study was prospectively registered on the NCT Trial Center (identification number: NCT04492748 ) on 30.07.2020.
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Daley P, Menu P, Louguet B, Crenn V, Dauty M, Fouasson-Chailloux A. Interest of platelet rich plasma in Achilles tendon rupture management: a systematic review. PHYSICIAN SPORTSMED 2022; 50:463-470. [PMID: 34392780 DOI: 10.1080/00913847.2021.1969216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Acute Achilles tendon rupture (ATR) is a disabling sport-related injury. Its management involves conservative treatment with early weight-bearing or surgical treatment. Platelet-rich plasma (PRP) has raised interest as an adjuvant for treatment, given its properties on tendon repair and its anti-inflammatory effect. We aimed to assess clinical impact of PRP use in surgical or non-surgical treatment of acute ATR: range of motion, muscle strength, function, return to sport and adverse events. METHOD A systematic literature research was performed using PubMed, ScienceDirect, and Google Scholar databases to collect studies reporting clinical outcomes after acute ATR treated with PRP. RESULTS Eight studies were eligible and included 543 acute ATR. Four were randomized comparative studies. A total of 128 patients were treated surgically and 415 were treated conservatively, 271 received PRP injection. Five studies described the type of PRP used, which was variable. Only one study including 12 patients found significant outcomes in favor of the PRP group, with a 4-week earlier recovery of a normal range of motion and a 7-week earlier return to running. No difference in clinical or morphological evaluations, strength measurement, and functional outcomes was found in other studies both at short and long-term. PRP did not seem to modify the frequency of adverse events. CONCLUSIONS Data are not clearly in favor of a significant effect of the PRP use for treatment of ATR. There might be a slight effect on evolution during the first months. Its interest should be assessed in future studies with strong methodology.
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Affiliation(s)
- Pauline Daley
- Chu Nantes, Service De Médecine Physique Et Réadapatation Locomotrice Et Respiratoire, Nantes, France.,Chu Nantes, Service De Médecine Du Sport, Nantes, France
| | - Pierre Menu
- Chu Nantes, Service De Médecine Physique Et Réadapatation Locomotrice Et Respiratoire, Nantes, France.,Chu Nantes, Service De Médecine Du Sport, Nantes, France.,Irms, Institut Régional De Médecine Du Sport, Nantes, France.,Inserm, Umr 1229, RMeS, Regenerative Medicine and Skeleton, Université De Nantes, Oniris, Nantes, France
| | - Bastien Louguet
- Chu Nantes, Service De Médecine Du Sport, Nantes, France.,Irms, Institut Régional De Médecine Du Sport, Nantes, France
| | - Vincent Crenn
- Chu Nantes, Clinique Chirurgicale Orthopédique Et Traumatologique, Nantes, France
| | - Marc Dauty
- Chu Nantes, Service De Médecine Physique Et Réadapatation Locomotrice Et Respiratoire, Nantes, France.,Chu Nantes, Service De Médecine Du Sport, Nantes, France.,Irms, Institut Régional De Médecine Du Sport, Nantes, France.,Inserm, Umr 1229, RMeS, Regenerative Medicine and Skeleton, Université De Nantes, Oniris, Nantes, France
| | - Alban Fouasson-Chailloux
- Chu Nantes, Service De Médecine Physique Et Réadapatation Locomotrice Et Respiratoire, Nantes, France.,Chu Nantes, Service De Médecine Du Sport, Nantes, France.,Irms, Institut Régional De Médecine Du Sport, Nantes, France.,Inserm, Umr 1229, RMeS, Regenerative Medicine and Skeleton, Université De Nantes, Oniris, Nantes, France
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Tossolini Goulart L, Matsunaga FT, Belloti JC, Faloppa F, Paim TS, Tamaoki MJS. Effectiveness of subacromial injections in rotator cuff lesions: systematic review and meta-analysis protocol. BMJ Open 2022; 12:e062114. [PMID: 36323483 PMCID: PMC9639075 DOI: 10.1136/bmjopen-2022-062114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Subacromial injections are therapeutic options for rotator cuff injuries, with consistent results not well established yet for each drug applied. The objective of this systematic review and meta-analysis is to analyse the effectiveness of the substances used in subacromial injections for the treatment of rotator cuff injuries and shoulder impingement syndrome, considering the functional gain and pain improvement of the shoulder. METHODS AND ANALYSIS Beginning in November 2022, we will perform a detailed search using the MEDLINE/PubMed, EMBASE, Cochrane Central Register of Controlled Trials and LILACS databases. Relevant grey literature (reference lists, conference abstracts and academic papers) will also be included.Two reviewers will independently screen and extract the information from the literature. Bias and quality of the included studies will be evaluated using the risk of bias assessment tool provided by the Cochrane Collaboration. Statistical analyses will be performed using Review Manager V.5.4 software. ETHICS AND DISSEMINATION Approval and patient informed consent are not required because we will only include published literature. The results of this research will be disseminated in a peer-reviewed journal and likely through other scientific events. PROSPERO REGISTRATION NUMBER CRD42020199292.
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Affiliation(s)
- Luana Tossolini Goulart
- Orthopaedics and Traumatology - Division of Hand Surgery and Upper Limb, Universidade Federal de São Paulo - Escola Paulista de Medicina, São Paulo, Brazil
| | - Fabio Teruo Matsunaga
- Orthopaedics and Traumatology - Division of Hand Surgery and Upper Limb, Universidade Federal de São Paulo - Escola Paulista de Medicina, São Paulo, Brazil
| | - João Carlos Belloti
- Orthopaedics and Traumatology - Division of Hand Surgery and Upper Limb, Universidade Federal de São Paulo - Escola Paulista de Medicina, São Paulo, Brazil
| | - Flavio Faloppa
- Orthopaedics and Traumatology - Division of Hand Surgery and Upper Limb, Universidade Federal de São Paulo - Escola Paulista de Medicina, São Paulo, Brazil
| | - Thays Sellan Paim
- Universidade Federal de São Paulo - Escola Paulista de Medicina, São Paulo, Brazil
| | - Marcel Jun Sugawara Tamaoki
- Orthopaedics and Traumatology - Division of Hand Surgery and Upper Limb, Universidade Federal de São Paulo - Escola Paulista de Medicina, São Paulo, Brazil
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15
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Pasculli RM, Bowers RL. Evidence-based Management of Rotator Cuff Tears (Acute and Chronic). CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2022. [DOI: 10.1007/s40141-022-00363-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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16
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Thu AC. The use of platelet-rich plasma in management of musculoskeletal pain: a narrative review. JOURNAL OF YEUNGNAM MEDICAL SCIENCE 2022; 39:206-215. [PMID: 35673831 PMCID: PMC9273137 DOI: 10.12701/jyms.2022.00290] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/17/2022] [Indexed: 01/16/2023]
Abstract
Musculoskeletal pain is the most common pain reported by patients. Platelet-rich plasma (PRP) is widely used to treat musculoskeletal pain. However, the efficacy of PRP to treat this pain remains controversial. This review highlights the application of PRP in the treatment of musculoskeletal pain. PRP treatment appears to reduce pain and improve function in patients with musculoskeletal pain. However, there are limitations to the currently published studies. These limitations include the PRP preparation methods, type of activators, types of pathology to be treated, methods and times of administration, and association of PRP with other treatments.
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Affiliation(s)
- Aung Chan Thu
- Department of Physical Medicine and Rehabilitation, University of Medicine, Mandalay, Myanmar
- Corresponding author: Aung Chan Thu, MD, PhD Department of Physical Medicine and Rehabilitation, University of Medicine, 30th Street, Between 73rd & 74th Streets, Mandalay, Myanmar Tel: +95-9977277511 • E-mail:
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Alben MG, Gambhir N, Virk MS. Isolated infraspinatus musculotendinous junction tear treated with open repair and dermal allograft augmentation: a case report with 5-year outcome. J Surg Case Rep 2022; 2022:rjac269. [PMID: 35783241 PMCID: PMC9246283 DOI: 10.1093/jscr/rjac269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 05/22/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
We report the 5-year outcome of an isolated, atraumatic full-thickness infraspinatus myotendinous junction tear treated with open surgical repair. The index patient developed severe pain and weakness in external rotation strength following a subacromial corticosteroid injection. Magnetic resonance imaging and ultrasound of the shoulder demonstrated a full-thickness myotendinous junction tear with extensive muscle edema, mild atrophy and a spinoglenoid notch varix. Due to persistent, worsening pain and presence of ER weakness, the patient underwent primary infraspinatus muscle–tendon repair with allograft augmentation via an arthroscopic-assisted open posterior approach. The patient had an uneventful postoperative course with a resolution of pain and improvement in ER strength, which is maintained at the latest 5-year follow-up. This case report highlights a favorable long-term outcome of an isolated infraspinatus myotendinous junction tear treated with primary muscle–tendon repair and dermal allograft augmentation.
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Affiliation(s)
- Matthew G Alben
- Division of Shoulder and Elbow Surgery , Department of Orthopedic Surgery, , New York, NY , USA
- NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health , Department of Orthopedic Surgery, , New York, NY , USA
| | - Neil Gambhir
- Division of Shoulder and Elbow Surgery , Department of Orthopedic Surgery, , New York, NY , USA
- NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health , Department of Orthopedic Surgery, , New York, NY , USA
| | - Mandeep S Virk
- Division of Shoulder and Elbow Surgery , Department of Orthopedic Surgery, , New York, NY , USA
- NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health , Department of Orthopedic Surgery, , New York, NY , USA
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Huang SH, Hsu PC, Wang KA, Chou CL, Wang JC. Comparison of single platelet-rich plasma injection with hyaluronic acid injection for partial-thickness rotator cuff tears. J Chin Med Assoc 2022; 85:723-729. [PMID: 35507030 DOI: 10.1097/jcma.0000000000000736] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Partial-thickness rotator cuff tears (PTRCTs) is not uncommon, and various nonsurgical injection therapy for PTRCTs emerged. Platelet-rich plasma (PRP) and hyaluronic acid (HA) injection were proposed for treating PTRCTs; however, the relation of dose among injectates was still lacking. METHODS This was a prospective, nonrandomized, comparative study. The aim of the study was to compare the effects of ultrasound-guided single PRP injection with three doses of HA injection, combination of postinjection rehabilitation, for treating PTRCTs. Subjects received either ultrasound-guided PRP injection and rehabilitation exercise, or ultrasound-guided subacromial HA injection and rehabilitation exercise. Shoulder Pain and Disability Index (SPADI), range of motion (ROM), pain visual analog scale (VAS), and Constant-Murley Shoulder Score (CMSS) were recorded before injection, and at 1 and 3 months after injection. RESULTS Forty-eight patients were enrolled. They received either ultrasound-guided single PRP (n = 24) intralesional and peritendinous injection or three doses of HA (n = 24) subacromial injection plus rehabilitation exercise. In the PRP group, SPADI scores, VAS scores, CMSS significantly improved at 1-month and 3-month follow up; flexion and abduction ROM significantly increased at 3-month follow up. In the HA group, SPADI scores, VAS during overhead activities, VAS night pain, and CMSS significantly improved in the first and third months; flexion and active abduction ROM significantly increased in the third month. The PRP group revealed significantly better passive abduction ROM and CMSS at third month than HA group. CONCLUSION Ultrasound-guided single PRP injection exhibited comparable benefit to three doses of HA injection in patients with PTRCTs short-termly, with an extended effect regarding passive shoulder abduction ROM and CMSS.
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Affiliation(s)
- Shou-Hsien Huang
- Department of Physical Medicine and Rehabilitation, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
| | - Po-Cheng Hsu
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Kevin A Wang
- Divison of General Surgery, Department of Surgery, Shin-Kong Memorial Hospital, Taipei, Taiwan, ROC
- School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan, ROC
| | - Chen-Liang Chou
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Jia-Chi Wang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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New Trends in Shoulder Surgery from Biomechanics to the Operating Room. J Clin Med 2021; 10:jcm10112498. [PMID: 34198736 PMCID: PMC8201278 DOI: 10.3390/jcm10112498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 06/01/2021] [Indexed: 11/17/2022] Open
Abstract
After a rigorous peer review process, twelve papers were accepted and published [...].
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Prodromos CC, Finkle S, Prodromos A, Chen JL, Schwartz A, Wathen L. Treatment of Rotator Cuff Tears with platelet rich plasma: a prospective study with 2 year follow-up. BMC Musculoskelet Disord 2021; 22:499. [PMID: 34051761 PMCID: PMC8164813 DOI: 10.1186/s12891-021-04288-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 04/21/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Surgical treatment of full-thickness rotator cuff (RC) tears is associated with generally good results. There is no consensus regarding treatment of partial thickness tears that fail conservative treatment. The purpose of this study was to look at the efficacy and confirm the safety of dual injection PRP into the shoulder of patients with rotator cuff pathology who have failed conservative treatment with followup to two years. METHODS Seventy-one shoulders with MRI confirmed, rotator cuff pathology who failed conservative treatment, had dual PRP injection into the rotator cuff. Global improvement, Quick DASH and VAS scores were collected at 6, 12, and 24 months after treatment and comparison of means was used to analyze changes. RESULTS No adverse events were seen in any patient. Based on global rating scores positive results were seen in 77.9 % of patients at 6 months, 71.6 % at 1 year, and 68.8 % of patients at 2 years. Mean VAS scores improved from 50.2 [CI 44.4-56.0] pre-injection to 26.2 [CI 19.5-32.9] at 6 months, 22.4[CI 16.1-28.7] at 1 year and 18.2 [CI 12.3-24.1] at 2 years (p < 0.0001 for all). The mean Q- DASH scores (0-100, 100 worse) improved from 39.2 [CI 34.3-44.1] for all patients before treatment to 20.7[CI 15.0-26.4] at 6 months, 18.0[CI 12.9-23.1] at 1 year, and 13.8 [CI 8.4-18.8] at 2 years (p < 0.0001 for all). No patient with partial tear had clinical evidence of progression to full thickness tear. When separated into subgroups based on rotator cuff status, all subgroups showed improvement. Patients in the > 50 % partial tear group had the best overall improvement based on Global Rating scores while those in the tendinitis group had the poorest outcomes. CONCLUSIONS PRP injection is a safe and effective treatment for RC cuff injury in patients who have failed conservative treatment of activity modification and physical therapy without deterioration of results two years after treatment. Better results are obtained with greater structural tendon damage than in shoulders with inflammation without structural damage. TRIAL REGISTRATION This is not a clinical trial.
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Affiliation(s)
- Chadwick C Prodromos
- Illinois Sportsmedicine and Orthopaedic Centers, 1714 Milwaukee Ave, 60025, Glenview, IL, USA.
| | - Susan Finkle
- Illinois Sportsmedicine and Orthopaedic Centers, 1714 Milwaukee Ave, 60025, Glenview, IL, USA
| | - Alexandra Prodromos
- Illinois Sportsmedicine and Orthopaedic Centers, 1714 Milwaukee Ave, 60025, Glenview, IL, USA
| | - Jasmine Li Chen
- Illinois Sportsmedicine and Orthopaedic Centers, 1714 Milwaukee Ave, 60025, Glenview, IL, USA
| | - Aron Schwartz
- Illinois Sportsmedicine and Orthopaedic Centers, 1714 Milwaukee Ave, 60025, Glenview, IL, USA
| | - Lucas Wathen
- Illinois Sportsmedicine and Orthopaedic Centers, 1714 Milwaukee Ave, 60025, Glenview, IL, USA
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