Comparison of the effects of platelet-rich plasma and corticosteroid injection in rotator cuff disease treatment: a systematic review and meta-analysis
Peng Y, Li F, Ding Y, Sun X, Wang G, Jia S, Zheng C
Journal of shoulder and elbow surgery. 2023
BACKGROUND Platelet-rich plasma (PRP) and corticosteroids are used to treat rotator cuff diseases. However, few reviews have compared the effects of these two treatments. In this study, we compared the effects of PRP and corticosteroid injection on the prognosis of rotator cuff diseases. METHODS According to the Cochrane Manual of Systematic Review of Interventions, the PubMed, Embase, and Cochrane databases were searched comprehensively. Two independent authors screened suitable studies and performed data extraction and risk of bias assessment. Only randomized controlled trials (RCTs) comparing the effects of PRP and corticosteroid in the treatment of rotator cuff injuries were included, as measured by clinical function and pain during different follow-up periods. RESULTS Nine studies with 469 patients were included in this review. In short-term treatment, corticosteroids were superior to PRP in the improvement of constant, SST, and ASES scores (MD -5.08, 95%CI -10.26, 0.06; P = .05 and MD -0.97, 95%CI -1.68, -0.07; P = .03 and MD -6.67, 95%CI -12.85, -0.49; P = .03, respectively). No statistically difference was observed between the two groups at mid-term (P> .05), and the recovery of the SST and ASES scores in PRP treatment was significantly better than that in corticosteroid treatment in the long-term (MD 1.21, 95%CI 0.68, 1.74; P < .00001 and MD 6.96, 95%CI 3.90, 9.61; P < .00001, respectively). In pain reduction based on VAS score, corticosteroids led to better pain reduction (MD 0.84, 95%CI 0.03, 1.64; P = .04), but no significant difference was observed in pain reduction between the two groups in the any term (P> .05). However, these differences did not reach the minimum clinically important difference. CONCLUSION Current analysis showed that corticosteroids have better efficacy in short-term, whereas PRP is more beneficial for long-term recovery. However, no difference was observed in the mid-term efficacy between the two groups. RCTs with longer follow-up periods and larger sample sizes are also needed to determine the optimal treatment.
Leukocyte-Rich and Leukocyte-Poor Platelet-Rich Plasma in Rotator Cuff Repair: A Meta-analysis
Peng Y, Guanglan W, Jia S, Zheng C
International journal of sports medicine. 2022
To systematically review of randomized controlled trials(RCTs) to compared the effects of leukocyte-rich and leukocyte-poor platelet-rich plasma in arthroscopic rotator cuff repair. Two independent reviewers comprehensively searched PubMed, Embase, and Cochrane library databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Comparison of leukocyte-rich platelet-rich plasma or leukocyte-poor platelet-rich plasma in rotator cuff repair in a level I RCTs. Methodological quality assessment was carried out using Cochrane Review Manager 5.3 software. P<0.05 was considered statistically significant. Nine RCTs with 540 patients were included in this review. Meta-analysis showed that leukocyte-poor platelet-rich plasma in significantly reduced retear rate in rotator cuff repair [RR=0.56 95%CI (0.42,0.75); P＜0.05), and in clinical results, the constant score [MD=3.67, 95%CI (1.62,5.73); P=0.0005], UCLA score [MD=1.60, 95%CI (0.79,2.42); P=0.0001], ASES score [MD=2.16, 95%CI(0.12,4.20);P=0.04] were significantly improved. There was a significant result in favor of PRP for the Constant score [MD=-1.24, 95%CI(-1.50,-0.99); P＜0.00001], while SST scores were not significantly different among all groups [MD=0.21, 95%CI(-0.21,0.64); P=0.32]. In conclusion, leukocyte-poor platelet-rich plasma can improved the clinical function and reduced retear rate in arthroscopic rotator cuff repair. In contrast, the efficacy of leukocyte-rich platelet-rich plasma was not significantly improved with the exception of VAS score.