1905 - Corticosteroids versus platelet-rich plasma injections for treatment of rotator cuff injuries

Rotator cuff injuries are a common cause of shoulder pain due to injury or degeneration of the tendon that occurs over time. The study aim was to examine the effectiveness of regenerative injection therapy, specifically protein rich plasma (PRP) injections compared to corticosteroid (CS) injections for rotator cuff injuries.

Design:

We systematically reviewed randomized controlled trials involving adults published from 2013 to 2023. We included studies that i) compared corticosteroids and PRP and ii) assessed levels of pain and function. We excluded studies that i) examined the effects of other types of injections or b) involved other study designs. Study quality was assessed using the PEDro scale and classified as excellent (9-10), good (6-8), moderate (4-5) or poor (≤3). We conducted meta-analyses and compared changes in pain and DASH scores using standardized mean differences and summary effect sizes (ES). We categorized ESs as small (0.08–0.18), medium (0.19–0.40) and large (≥0.41) based upon Rehabilitation Treatment Specification System.

Results:

Eight studies (four excellent, four good quality) met our selection criteria. Pain scores did not differ between groups at one (p=0.14) and 12 months (p=0.26) between the two groups. The PRP group had greater pain reduction with large ESs at three (-0.64, p=0.03) and six months (-1.71; p< 0.01). For function, the CG group had better scores on the DASH at one month group (-0.45, large ES, p =0.02). However, the PRP group had better function at three (-0.24; moderate ES, p=0.04), six (-0.68; large ES p< 0.01) and 12 months (-0.69; large ES, p< 0.01) supporting higher function in the PRP groups (reflected by lower DASH scores).

Conclusions:

Use of PRP injections resulted in short term pain relief. However, pain reduction at three and six months was accompanied by better function in the PRP group, which continued to persist at 1 year.