What is the treatment approach for a rotator cuff partial rupture ligament using Platelet-rich Plasma (PRP)?

From the Guidelines

The use of platelet-rich plasma (PRP) for the treatment of rotator cuff partial rupture ligament is not supported by strong evidence, and its routine use is not recommended. According to the most recent and highest quality study, limited evidence does not support the routine use of PRP for the treatment of rotator cuff tendinopathy or partial tears 1.

Treatment Approach

When considering treatment options for partial rotator cuff tears, it's essential to weigh the benefits and risks of each approach. While PRP therapy may be considered for patients who have failed conservative management and wish to avoid surgery, the evidence supporting its use is limited.

• The typical treatment approach for rotator cuff injuries includes a combination of physical therapy, pain management, and, in some cases, surgical intervention.
• For patients with partial tears, a structured rehabilitation program lasting 6-12 weeks may be recommended, which gradually progresses from gentle range of motion exercises to strengthening and functional activities.
• The use of PRP therapy, if considered, should be done under the guidance of a qualified healthcare professional, and patients should be aware of the potential risks and benefits.

Evidence-Based Recommendation

Based on the available evidence, the routine use of PRP for the treatment of rotator cuff partial rupture ligament is not recommended 1. However, for patients who have failed conservative management and wish to avoid surgery, PRP therapy may be considered as a minimally invasive treatment option. It's essential to note that the evidence supporting the use of PRP therapy is limited, and more research is needed to fully understand its effectiveness.

• A study published in the Journal of the American Academy of Orthopaedic Surgeons found that limited evidence supports the use of liquid platelet–rich plasma in the context of decreasing retear rates 1.
• Another study published in the Journal of Thrombosis and Haemostasis proposed a new classification system for PRP, which may help standardize the preparation and use of PRP therapy 1.

From the Research

Treatment Approach for Rotator Cuff Partial Rupture Ligament using Platelet-rich Plasma (PRP)

• The treatment of partial thickness rotator cuff tears (PTRCTs) remains controversial, with most studies focusing on surgical techniques or outcomes, and few on conservative and new management methods like PRP treatment 2.
• PRP injection has shown positive effects on improving PTRCT complaints, including pain, function, DASH score, and shoulder joint range of motion 2.
• A prospective randomized controlled study compared the results of subacromial injection of PRP versus corticosteroid injection therapy in patients with symptomatic partial rotator cuff tears, finding that both groups showed statistically significant better clinical outcomes over time, but with a significant difference in favor of the PRP group at 12 weeks after injection 3.
• A systematic review of randomized control trials found that PRP injections showed improved functional outcomes in patients with PTRCTs, regardless of the injection site, but with inconclusive evidence on the ideal location for injection 4.
• Another study found that the combined use of sodium hyaluronate (SH) and PRP in the treatment of small to medium PTRCTs yielded better clinical outcomes than SH or PRP alone, with significant improvements in Constant score, ASES score, and visual analog scale scores 5.

Injection Locations and Techniques

• Studies have investigated different injection locations, including the glenohumeral joint, subacromial bursa, and intratendinous injections, with varying results 4.
• Intra-articular PRP injections showed a 46.2% improvement in the Disabilities of the Arm, Shoulder, and Hand score at 12-month follow-up, while subacromial injections showed improvement compared to normal saline at 3,6, and 12 months 4.
• Intratendinous injections were found to be superior in the Shoulder Pain and Disability Index scores at 66.1% improvement at 3 months and 71.6% at 6 months after two PRP injections when compared to dry needling 4.

Efficacy and Safety of PRP Treatment

• PRP treatment has been shown to be safe and easy to prepare and apply, with improving patient condition, making it a viable option for treating PTRCTs 2.
• However, the clinical data does not conclusively prove a benefit from PRP, and discernment is required in evaluating the published results, with different PRPs potentially acting differently and results being dose-dependent 6.