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Updated: Jan 10, 2026
Arthroscopic Management of Massive Irreparable Rotator Cuff Tears: Whole Rotator Cable Reconstruction Using Proximal Biceps Tendon Autograft
Published on: June 6, 2025
The evolving efficacy landscape of intra-articular injections for rotator cuff injuries over time: a network
Morong Wu1, Chenshu Yan2, Yan Xu3
1The Second Clinical Medical College, Zhejiang Chinese Medical University, 5th Floor, Hangzhou, 310053, Zhejiang, China.
Background:
Rotator cuff injury (RCI), a leading cause of shoulder disability, necessitates effective non-surgical interventions. Despite widespread use of intra-articular injections (corticosteroids, hyaluronic acid [HA], prolotherapy, platelet-rich plasma [PRP]), comparative efficacy across short-, mid-, and long-term outcomes remains unclear due to heterogeneous evidence.
Purpose:
To systematically review the literature to compare corticosteroids, hyaluronic acid, prolotherapy, and platelet-rich plasma for rotator cuff injuries, using network meta-analysis stratified by short-, mid-, and long-term outcomes.
Methods:
A comprehensive search was conducted across PubMed, Embase, Cochrane Library, Web of Science, Scopus, CNKI, VIPC, and Wanfang Data up to May 2025. Pain (VAS) and functional outcomes (e.g., Constant-Murley Score) were assessed at short- (≤ 1 month), mid- (1-3 months), and long-term (> 3 months) intervals. Frequentist models with random effects ranked interventions via SUCRA.
Results:
Twenty-nine RCTs (1800 patients) were included. For pain relief, prolotherapy consistently ranked highest across all timeframes. PRP also exhibited favorable long-term analgesic efficacy. Corticosteroids showed short-term benefits but inferior long-term efficacy. For functional improvement, HA demonstrated the best short-term results, whereas prolotherapy was optimal for mid-term recovery. Long-term functional outcomes favored HA and prolotherapy. The detailed SUCRA values and rankings for all interventions and timepoints are presented in Table 2.
Conclusions:
Comparative efficacy analysis suggests temporal variations in treatment outcomes: prolotherapy and HA offer the most favorable early (≤ 3 months) symptom control for both pain and function. For sustained pain relief (> 3 months), prolotherapy and PRP rank highest, while HA and prolotherapy are associated with better long-term functional outcomes. Corticosteroids appear most effective for short-term analgesia, with diminishing efficacy over longer durations. This evidence supports a shift from using a single injection agent towards a tailored strategy that selects different injections based on the patient's symptoms and the specific treatment phase to achieve optimal outcomes. PROSPERO registration: PROSPERO registration number: CRD42025632416.
Level Of Evidence:
Level I Systematic Review and MetaAnalysis.
