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Erschienen in: Current Reviews in Musculoskeletal Medicine 4/2018

08.09.2018 | Protein-Rich Plasma: From Bench to Treatment of Arthritis (S Choate and J Tokish, section editors)

Platelet-rich plasma and the shoulder: clinical indications and outcomes

verfasst von: Andrew Schneider, Rebecca Burr, Nickolas Garbis, Dane Salazar

Erschienen in: Current Reviews in Musculoskeletal Medicine | Ausgabe 4/2018

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Abstract

Purpose of Review

The orthopedic community has seen a rapid rise in the clinical use of platelet-rich plasma (PRP) in the management of shoulder pathologies over the past decade. The purpose of this paper is to review the current literature regarding the indications and outcomes of PRP for the surgical and non-surgical management of common shoulder pathologies, including rotator cuff tears.

Recent Findings

Multiple studies have been published recently regarding the use of PRP for the operative and non-operative treatment of rotator cuff tears. There has been less research published on the use of PRP in the management of other conditions of the shoulder. Despite attempts to standardize and classify PRP formulations, there remains great variation in the inter- and intra-subjection composition, preparation, and administration techniques of PRP, limiting the conclusions that can be drawn regarding the utility and effectiveness of this biologic treatment as reported by Mazzocca et al. (J Bone Joint Surg Am. 94(4):308–16, 2012).

Summary

Recent literature has shown equivocal to minor benefit of PRP use for shoulder pain, function, and healing. While few complications have been reported and PRP administration appears to carry little risk to the patient, the body of literature is currently inconclusive regarding the clinical benefit and cost-effectiveness of PRP in the treatment of shoulder pathology. As for PRP use specifically as an adjunct to surgical rotator cuff repairs, there is no clear consensus on its effectiveness in either clinical or structural outcomes. To further delineate the efficacy of PRP for shoulder pathology, it is essential that more double-blinded, randomized controlled investigations with large sample sizes and standardized PRP preparations be performed.
Literatur
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Zurück zum Zitat • Garbis N, Romeo AA, Van Thiel G, et al. Clinical indications and techniques for the use of platelet-rich plasma in the shoulder. 2011:1–5. https://doi.org/10.1053/j.otsm.2011.03.002. This paper is a review on the use of PRP in the non-operative and operative management of the shoulder based on current literature at the time of publication. The authors detail important clinical studies and their results and propose what future studies were needed to further clarify PRP’s effectiveness in the shoulder. CrossRef • Garbis N, Romeo AA, Van Thiel G, et al. Clinical indications and techniques for the use of platelet-rich plasma in the shoulder. 2011:1–5. https://​doi.​org/​10.​1053/​j.​otsm.​2011.​03.​002. This paper is a review on the use of PRP in the non-operative and operative management of the shoulder based on current literature at the time of publication. The authors detail important clinical studies and their results and propose what future studies were needed to further clarify PRP’s effectiveness in the shoulder. CrossRef
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Zurück zum Zitat • Say F, Gurler D, Bulbul M. Platelet-rich plasma versus steroid injection for subacromial impingement syndrome. J Orthop Surg (Hong Kong). 2016;24(1):62–6. https://doi.org/10.1177/230949901602400115. This study showed that improvements in pain in patients with calcific tendonitis were greater in patients who received corticosteroid injections compared to those who received PRP injections. CrossRef • Say F, Gurler D, Bulbul M. Platelet-rich plasma versus steroid injection for subacromial impingement syndrome. J Orthop Surg (Hong Kong). 2016;24(1):62–6. https://​doi.​org/​10.​1177/​2309499016024001​15. This study showed that improvements in pain in patients with calcific tendonitis were greater in patients who received corticosteroid injections compared to those who received PRP injections. CrossRef
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Zurück zum Zitat • Hurley ET, Lim Fat D, Moran CJ, Mullett H. The efficacy of platelet-rich plasma and platelet-rich fibrin in arthroscopic rotator cuff repair: a meta-analysis of randomized controlled trials. Am J Sports Med. 2018;79(1):363546517751397. https://doi.org/10.1177/0363546517751397. This meta-analysis found that PRP use significantly decreased rates of incomplete tendon healing in small-medium tears, medium-large tears, and all tears combined compared to control groups. CrossRef • Hurley ET, Lim Fat D, Moran CJ, Mullett H. The efficacy of platelet-rich plasma and platelet-rich fibrin in arthroscopic rotator cuff repair: a meta-analysis of randomized controlled trials. Am J Sports Med. 2018;79(1):363546517751397. https://​doi.​org/​10.​1177/​0363546517751397​. This meta-analysis found that PRP use significantly decreased rates of incomplete tendon healing in small-medium tears, medium-large tears, and all tears combined compared to control groups. CrossRef
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Zurück zum Zitat • Jo CH, Shin JS, Lee YG, et al. Platelet-rich plasma for arthroscopic repair of large to massive rotator cuff tears: a randomized, single-blind, parallel-group trial. Am J Sports Med. 2013;41(10):2240–8. https://doi.org/10.1177/0363546513497925. This study showed improvement in structural outcomes in patients who received PRP and underwent arthroscopic rotator cuff repair of large to massive tears. CrossRefPubMed • Jo CH, Shin JS, Lee YG, et al. Platelet-rich plasma for arthroscopic repair of large to massive rotator cuff tears: a randomized, single-blind, parallel-group trial. Am J Sports Med. 2013;41(10):2240–8. https://​doi.​org/​10.​1177/​0363546513497925​. This study showed improvement in structural outcomes in patients who received PRP and underwent arthroscopic rotator cuff repair of large to massive tears. CrossRefPubMed
Metadaten
Titel
Platelet-rich plasma and the shoulder: clinical indications and outcomes
verfasst von
Andrew Schneider
Rebecca Burr
Nickolas Garbis
Dane Salazar
Publikationsdatum
08.09.2018
Verlag
Springer US
Erschienen in
Current Reviews in Musculoskeletal Medicine / Ausgabe 4/2018
Elektronische ISSN: 1935-9748
DOI
https://doi.org/10.1007/s12178-018-9517-9

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