What is the efficacy of Platelet-rich Plasma (PRP) in treating rotator cuff tendinitis?

PRP for Rotator Cuff Tendinitis: Current Evidence

Limited evidence does not support the routine use of platelet-rich plasma (PRP) for the treatment of rotator cuff tendinopathy or partial tears. 1

Guideline Recommendations

The American Academy of Orthopaedic Surgeons (AAOS) 2020 guidelines provide a limited strength recommendation against routine PRP use for rotator cuff tendinopathy, meaning practitioners should exercise clinical judgment and be alert for emerging evidence, with patient preference playing a substantial role. 1

Key Distinction in PRP Applications

The evidence differentiates between two clinical scenarios:

For Non-Surgical Treatment (Tendinopathy/Partial Tears):

• Limited evidence does not support routine use of PRP injections 1
• This represents the weakest level of recommendation from AAOS 1

For Surgical Augmentation (Full-Thickness Tears):

• Strong evidence does NOT support biological augmentation with platelet-derived products for improving patient-reported outcomes 1
• However, limited evidence suggests liquid PRP may decrease retear rates after surgical repair 1

What You Should Do Instead

First-line treatment for rotator cuff tendinopathy should be:

• Exercise programs and/or NSAIDs (moderate strength recommendation) 1, 2
• Home exercise programs show significant improvements in pain at rest, nighttime pain, and functional scores after 3 months 2

Second-line intervention if conservative measures fail:

• A single corticosteroid injection with local anesthetic provides short-term improvement in pain and function (moderate evidence) 1, 2
• Avoid multiple repeated injections—limit to single injection for short-term relief 2, 3

Research Evidence Nuances

While some individual studies show promising results, the overall body of evidence remains inconclusive:

Studies showing potential benefit:

• One prospective study (n=30) showed VAS improvement from 7.4 to 1.9 at 12 weeks with good functional outcomes 4
• Another open-label study (n=18) demonstrated sustained improvement at 52 weeks with MRI improvement 5

Studies showing no superiority:

• A comparative study found PRP performed similarly to corticosteroid injections at 6,12, and 18 months with no significant differences in outcomes 6
• Multiple reviews conclude PRP may not be superior to standard physical therapy regimens 7
• Most studies fail to demonstrate clinical benefit compared to other non-operative treatments 8

Critical Limitations of Current PRP Evidence

The lack of strong recommendation stems from several methodological issues:

• No standardized platelet extraction methods 7
• No consensus on ideal platelet concentration 7
• Unclear whether single or multiple injections are needed 7
• Small sample sizes with short follow-up periods 7
• High dropout and noncompliance rates in some studies 7

Clinical Algorithm

For rotator cuff tendinopathy without full-thickness tear:

1. Start with: Exercise programs + NSAIDs for 3 months 1, 2
2. If inadequate response: Single corticosteroid injection 1
3. If still refractory: Consider PRP only after informed discussion about limited evidence, as patient preference should substantially influence this decision 1

Common Pitfalls to Avoid

• Do not use PRP as first-line treatment—it lacks evidence to support routine use over proven therapies 1
• Do not use opioids as first-line treatment—reserve strictly for rescue analgesia 2, 3
• Do not perform multiple corticosteroid injections—limit to single injection 2, 3
• Do not expect PRP to improve surgical outcomes—strong evidence shows no benefit for patient-reported outcomes in surgical augmentation 1