[PLATELET RICH PLASMA INJECTION AS TREATMENT FOR ROTATOR CUFF TENDINOPATHY AND AS AN AUGMENTATION FOR ROTATOR CUFF REPAIR].

Platelet rich plasma (PRP) intra-articular injections are gaining popularity worldwide. Albeit its vast application, its efficacy has not been proven unequivocally. This position statement was conducted for the Israeli Shoulder and Elbow Society and is intended to guide practitioners on treatment with PRP injections. Platelets secrete growth factors as part of their function which stimulates angiogenesis, cellular proliferation and tissue repair. Four main PRP subtypes exist: activated, non-activated, leucocyte-rich and leukocyte-poor. The function of leukocytes in PRP is not yet clearly understood and may locally cause harm. There are 3 main pathologies involving the shoulder and elbow in which PRP is being used: rotator cuff tendinopathy, rotator cuff tears and epicondylitis. Contraindications to PRP injection are infection, systemic disease presenting at the injection site, bone marrow pathology, thrombocytopenia, systemic steroids use and anticoagulant therapy. Most studies that explored the efficacy of PRP for rotator cuff tendinopathy failed to demonstrate any clinical benefit when compared to other non-operative treatments. Research shows that PRP injection improves rotator cuff tear healing when used as an augmentation to surgical repair, irrespective of tear size. Furthermore, high quality studies reported less pain in the early postoperative period with PRP augmentation in rotator cuff repair surgery but no significant changes to post-operative shoulder function. Larger studies were conducted on PRP injection to various joints which reported no side effects and approved its safety.