PRP for Rotator Cuff Tears
PRP injection is not routinely recommended for rotator cuff tears, whether partial-thickness tears, tendinopathy, or as surgical augmentation, based on strong and limited evidence from the American Academy of Orthopaedic Surgeons. 1
Non-Surgical Treatment Context
For Partial-Thickness Tears and Tendinopathy
Limited evidence does not support routine PRP use for rotator cuff tendinopathy or partial tears, meaning you should exercise clinical judgment and prioritize patient preference over this intervention. 1
Start with exercise programs and NSAIDs as first-line treatment for 3 months, which have moderate evidence for significant improvements in pain and functional scores. 2, 3
Consider a single corticosteroid injection with local anesthetic if first-line treatment fails, as moderate evidence supports short-term improvement in both pain and function. 2, 3
Only consider PRP after informed discussion about limited evidence if both exercise/NSAIDs and corticosteroid injection have failed, recognizing this is not a guideline-supported routine approach. 2
Nuance in the Evidence
While the guideline recommendation is limited strength against routine PRP use, some research suggests potential benefit in specific contexts. One 2020 systematic review found PRP injections significantly more effective than corticosteroids for partial tears in long-term follow-up (pain and function), though not in short-term. 4
A 2023 study showed PRP injection into high-grade intrasubstance partial tears achieved equal effectiveness to surgical repair with shorter recovery time (3.3 vs 4.6 months). 5
However, a 2024 systematic review concluded there is inconclusive evidence regarding optimal injection location, PRP concentration, and ideal candidates. 6
Surgical Augmentation Context
For Full-Thickness Tears Undergoing Repair
Strong evidence does not support biological augmentation with platelet-derived products for improving patient-reported outcomes after rotator cuff repair surgery. 1, 2
Limited evidence suggests liquid PRP may decrease retear rates after surgical repair, though this does not translate to improved functional outcomes or quality of life. 1, 2
A 2011 prospective cohort study found PRP application during arthroscopic repair showed no acceleration in recovery for pain, range of motion, strength, or functional scores, with retear rates of 26.7% (PRP) vs 41.2% (conventional) that were not statistically different. 7
A 2020 critical review concluded that due to mixed results and lack of standardization, PRP cannot be recommended as an adjunct to rotator cuff repair at this time. 8
Common Pitfalls to Avoid
Do not use PRP as a first-line treatment when exercise programs and NSAIDs have moderate evidence and should be tried first. 2, 3
Avoid multiple corticosteroid injections as they compromise tissue integrity, but recognize that a single injection has better evidence than PRP for short-term benefit. 3, 9
Do not assume structural improvement (decreased retear rates) equals functional improvement – the evidence shows these may be disconnected outcomes with PRP. 1, 8
Recognize that older age predicts poorer outcomes with any rotator cuff intervention, making conservative management particularly appropriate for elderly patients rather than experimental biologics. 3
Clinical Algorithm
For symptomatic rotator cuff pathology:
Initiate supervised physical therapy immediately with range of motion and strengthening exercises. 3
Add NSAIDs or COX-2 inhibitors with acetaminophen for pain control. 3
If inadequate response after 3 months, add a single corticosteroid injection with local anesthetic for short-term relief. 2, 3
If still inadequate response, discuss surgical options based on tear size, patient age, comorbidities (especially diabetes), and functional demands. 3
PRP may be considered only after this algorithm fails and only after informed discussion that evidence is limited and does not support routine use. 2