The Effectiveness of Platelet-Rich Plasma in the Management of Rotator Cuff Tears: A Systematic Review and...

Platelet-rich plasma (PRP) injections have been proposed to enhance tendon healing and alleviate symptoms in rotator cuff tears, but clinical evidence of their efficacy remains mixed. This systematic review synthesizes the evidence from randomized controlled trials (RCTs) on PRP's effectiveness for rotator cuff tears. We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched PubMed, Excerpta Medica Database (EMBASE), and the Cochrane Library from inception through March 2025 for RCTs comparing PRP injection with placebo, corticosteroid injection, or no adjunct therapy in adults with partial- or full-thickness rotator cuff tears. Primary outcomes included pain [Visual Analog Scale (VAS)], functional scores [American Shoulder and Elbow Surgeons (ASES)], Constant-Murley score, and tendon healing on imaging. Thirty-six studies (approximately 2000 patients) met the inclusion criteria. PRP generally produced significant short-term pain relief, with pooled data showing lower VAS scores at six weeks, three months, six months, and one year compared with controls (all P<0.05). In terms of function, PRP often improved ASES and Constant-Murley scores during the first three to six months. However, long-term functional gains were inconsistent, and some trials reported no between-group differences. Regarding tendon healing, a large meta-analysis of arthroscopic repair RCTs (n=1359) found a significantly lower retear rate with PRP (16.5% vs 23.6%, P=0.002), while other trials found no difference. Current evidence suggests that PRP injection provides significant short-term pain reduction and functional improvement in adults with rotator cuff tears and may enhance tendon healing when used as a surgical adjunct. However, considerable heterogeneity in PRP protocols and mixed long-term results mean its definitive superiority over standard care is not firmly established. PRP may be considered a potential adjunct, but further high-quality, standardized RCTs are needed.