Sports Medicine Department, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
Department of Orthopedic Surgery, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
J Orthop Surg Res. 2021 May 21;16(1):333. doi: 10.1186/s13018-021-02470-x.
Studies evaluating the role of both corticosteroids and platelet-rich plasma (PRP) in the treatment of rotator cuff (RC) tendinopathies have been contradicting. We compared structural and clinical changes in RC muscles after corticosteroids and PRP injections.
This is a randomized double-blind clinical trial. All individuals with diagnosis of RC tendinitis during 2014-2017 were considered. Individuals were randomly allocated to either receive PRP or corticosteroids. Overall, 3cc of PRP was injected within the subacromial joint and another 3cc was injected at the site of the tendon tear, under the guide of sonography. For the corticosteroid group, 1cc of Depo-medrol 40mg and 1cc of lidocaine (2%) was injected within the subacromial joint.
Overall, 58 patients entered the study. Comparison of pain, range of motion (ROM), Western Ontario RC (WORC), Disability of Arm-Hand-Shoulder (DASH) scores, and supraspinatus thickness showed significant improvement during follow-ups in both groups (p<0.05). During 3 months of follow-up, pain improvement was significantly better within the PRP group during (from 6.66±2.26 to 3.08±2.14 and 5.53±1.80 to 3.88±1.99, respectively; p=0.023). Regarding ROM, the PRP group had significant improvement in adduction (20.50°±8.23° to 28°±3.61° and 23.21°±7.09° to 28.46°±4.18° for the PRP and corticosteroid groups, respectively; p=0.011) and external rotation (59.66°±23.81° to 76.66°±18.30° and 57.14°±24.69° to 65.57°±26.39°, for the PRP and corticosteroid groups, respectively; p=0.036) compared to the corticosteroid group.
We found that PRP renders similar results to that of corticosteroids in most clinical aspects among patients with RC tendinopathies; however, pain and ROM may show more significant improvement with the use of PRP. Considering that the use of corticosteroids may be contraindicated in some patients and may be associated with the risk of tendon rupture, we suggest the use of PRP in place of corticosteroid-based injections among patients with RC tendinopathy.
Clinical trial registration code: IRCT201302174251N9.
评估皮质类固醇和富血小板血浆（PRP）在肩袖（RC）肌腱病治疗中的作用的研究结果相互矛盾。我们比较了 RC 肌肉在皮质类固醇和 PRP 注射后的结构和临床变化。
这是一项随机双盲临床试验。所有在 2014 年至 2017 年期间被诊断为 RC 肌腱炎的个体都被认为符合条件。个体被随机分配接受 PRP 或皮质类固醇治疗。总体而言，在超声引导下，将 3cc 的 PRP 注入肩峰下关节内，将另外 3cc 的 PRP 注入肌腱撕裂部位。对于皮质类固醇组，将 1cc 的德保美 40mg 和 1cc 的利多卡因（2%）注入肩峰下关节内。
总体而言，有 58 名患者进入研究。两组在随访过程中疼痛、活动范围（ROM）、安大略西部 RC（WORC）、手臂-肩部-手残疾（DASH）评分和冈上肌厚度的比较均显示出显著改善（p<0.05）。在 3 个月的随访期间，PRP 组的疼痛改善明显更好（从 6.66±2.26 到 3.08±2.14 和 5.53±1.80 到 3.88±1.99，分别；p=0.023）。关于 ROM，PRP 组在内收（20.50°±8.23°到 28°±3.61°和 23.21°±7.09°到 28.46°±4.18°，分别；p=0.011）和外展（59.66°±23.81°到 76.66°±18.30°和 57.14°±24.69°到 65.57°±26.39°，分别；p=0.036）方面的改善明显优于皮质类固醇组。
我们发现 PRP 在 RC 肌腱病患者的大多数临床方面与皮质类固醇产生相似的结果；然而，使用 PRP 可能会使疼痛和 ROM 得到更显著的改善。考虑到皮质类固醇的使用可能在某些患者中受到限制，并且可能与肌腱断裂的风险相关，我们建议在 RC 肌腱病患者中使用 PRP 代替基于皮质类固醇的注射。
临床试验注册号：IRCT201302174251N9。
