Friday, November 13, 2015

Is platelet-rich plasma (PRP) good for rotator cuff tendons?

Platelet-Rich Plasma Injection With Arthroscopic Acromioplasty for Chronic Rotator Cuff Tendinopathy

These authors conducted a Level 1 randomized controlled trial to investigate the effects of platelet-rich plasma (PRP) injection in patients with chronic rotator cuff tendinopathy.

60 patients (55% women) aged between 35 and 75 years with cuff tendinopathy but without full thickness cuff tears were randomized to arthroscopic acromioplasty alone or acromioplasty in combination with an injection of autologous PRP into the subacromial bursa. The autologous leucocyte-rich PRP and thrombin were prepared with the Magellan Autologous Platelet Separator System. From 50 mL of whole venous blood, approximately 5 mL of PRP and 1 mL of thrombin were collected. The PRP injection needle was placed into the subacromial space (bursa) under arthroscopic
guidance to confirm correct location. The PRP was injected into the subacromial space with dual syringes after the acromioplasty had been performed and the arthroscopic portals had been closed to prevent escape of the PRP injection.

Tendon biopsy specimens were taken for histology from approximately 5 to 10 mm posterior to the anterior edge of the supraspinatus tendon  at baseline during the surgical procedure and at the 3-month follow-up visit under ultrasound guidance.

There was no significant difference in the Oxford Shoulder Score between the two groups at any time point in the study. 

The number of blood vessels and tendon cellularity were significantly decreased in tissue biopsy specimens taken from PRP-treated patients. The expression of p53-positive apoptotic cells increased in shoulders having PRP but decreased in the controls. The authors concluded that PRP significantly altered the tissue characteristics in tendons after surgery with reduced cellularity and vascularity and increased levels of apoptosis.

Comment: This high level study did not show a clinical benefit of PRP and appears to demonstrate a biological effect of PRP that may be detrimental to the quality of the cuff tendon. Other posts on PRP and the rotator cuff can be found here and here and here, none of which shows a benefit.

In New York, single PRP injection has been estimated to cost $1000 and is often not covered by insurance. If we divide the benefit by the cost, the value of this treatment so far seems vanishingly small.
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