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Published on: January 4, 2019
Platelet Concentration Is Not Associated With Improved Pain for Partial-Thickness Rotator Cuff Tears Treated With
Joseph J Lim1, John W Belk1, Carson Keeter1
1Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA.
Background:
Platelet-rich plasma (PRP) has emerged as a nonoperative treatment option to manage pain and improve functionality in patients with partial-thickness rotator cuff tears. Previous studies examining the efficacy of PRP for the management of partial-thickness rotator cuff tears describe heterogeneous results.
Purpose:
To determine whether platelet concentration of a PRP injection as management for partial-thickness rotator cuff tears affects visual analog scale (VAS) pain scores.
Study Design:
Systematic review; Level of evidence, 1.
Methods:
A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to identify level 1 randomized controlled trials (RCTs) that evaluated the clinical efficacy of PRP for the management of partial-thickness rotator cuff tears. The search phrase used was "rotator cuff partial platelet rich plasma." Included RCTs were classified as utilizing high-dose or low-dose PRP based on their platelet concentration factor as greater than a 4-fold increase over whole blood. The primary outcome evaluated was the standardized mean differences of VAS scores. Mixed-effects and random effects meta-analyses were performed along with meta-regression to evaluate relationships in VAS scores associated with PRP platelet dose.
Results:
Ten studies met inclusion and exclusion criteria, including a total of 635 patients (PRP, n = 307; control, n = 328). The mean patient age at the time of injection was 50.6 years, the mean follow-up time was 10.0 months, and the mean male sex distribution was 44.4%. Of the 10 studies, 6 studies utilized high-dose PRP and 4 studies utilized low-dose PRP. In both the meta-analysis and the meta-regression analyses, there were no significant differences in mean postinjection VAS scores between platelet dosage groups (P = .36 and P = .37, respectively).
Conclusion:
Among level 1 RCTs reporting VAS pain scores after PRP injection for partial-thickness rotator cuff tears, platelet concentration was not significantly associated with improved pain outcomes. However, substantial heterogeneity and inconsistent reporting of PRP composition limit the certainty of this finding.
