Monday, July 29, 2013

Platelet-Rich Plasma (PRP): failure to make a difference

Platelet-Rich Plasma Injections in the Treatment of Chronic Rotator Cuff Tendinopathy A Randomized Controlled Trial With 1-Year Follow-up

There is a lot of interest in platelet-rich plasma (PRP) as a treatment of rotator cuff tear pathologies.

Even our own Academy states "Treatment with platelet-rich plasma holds great promise. Currently, however, the research studies to back up the claims in the media are lacking. Although PRP does appear to be effective in the treatment of chronic tendon injuries about the elbow, the medical community needs more scientific evidence before it can determine whether PRP therapy is truly effective in other conditions.   Even though the success of PRP therapy is still questionable,...."

These authors conducted a Level 1 randomized controlled trial of 40 patients, 18 to 70 years of age, with (1) a history of shoulder pain for >3 months during overhead-throwing activities, (2) MRI findings of RCT or partial tendon ruptures, and (3) a minimum 50% reduction in shoulder pain with subacromial injections of an anesthetic. Patients were randomized into a PRP group (n = 20) or placebo group (n = 20). Patients received an ultrasound-guided injection into the subacromial space that contained either 5 mL of PRP prepared from autologous venous blood or 5 mL of saline solution. All patients underwent a 6-week standard exercise program. 

While both the treatment and control groups showed significant improvements compared with baseline at all time points, comparison of the patients revealed no significant difference between the treatment and control groups in WORC, SPADI, and VAS scores at 1-year follow-up. The authors concluded that at 1-year follow-up, a PRP injection was found to be no more effective in improving quality of life, pain, disability, and shoulder range of motion than placebo in patients with chronic RCT who were treated with an exercise program.

Comment: the key finding here is that the placebo group improved as much as the PRP group, so claims that 'the patient got better after PRP, does not prove that PRP was effective.

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