Platelet-Rich Plasma (PRP) for Rotator Cuff Tears: Dual Injection Approach
Rotator cuff tears, particularly in cases where conservative treatments like physical therapy and NSAIDs fail, are commonly treated with surgery. Full-thickness tears often respond well to surgical interventions, but partial tears can have inconsistent outcomes. Traditional treatments like corticosteroid injections can alleviate pain but may lead to tendon atrophy. PRP, a promising therapy, has shown better results than steroid injections and physical therapy for rotator cuff tears, particularly at the 6-month post-treatment mark. Importantly, PRP tends to provide longer-term benefits as well.
Dual Injection PRP for Rotator Cuff Tears
Recent studies have explored the effectiveness of a dual-injection PRP technique for rotator cuff tears. Initial outcomes of single-site PRP injections have been positive, but some patients failed to improve. This failure was attributed to missing the pathology on the posterior (articular) side of the tendon with a single anterior injection. To address this, researchers proposed a two-injection method, targeting both the anterior and posterior compartments of the rotator cuff. This approach ensures that the entire tendon is treated with PRP, improving the chances of success.
A study conducted by Prodromos et al. (2021) tested the dual-injection PRP technique in 68 patients with rotator cuff injuries that failed conservative treatment. The PRP was prepared using a double-spin technique, and injections were administered under ultrasound guidance. Patients were instructed to rest for one week post-treatment and avoid NSAIDs, steroid injections, and physical activities that could worsen the injury.
Study Results
The study measured disability and pain at baseline, 6 months, 1 year, and 2 years after treatment.
• Disability Scores:
• Patients with partial tears showed significant improvements at all follow-up points (6 months, 1 year, and 2 years).
• Full tear patients showed improvement at 6 months, but the results became statistically significant at 1 and 2 years.
• Tendonitis patients had improvement at 2 years, but not statistically significant at earlier points.
• Pain Scores (on a scale of 0–100, with 10 being the worst pain):
• Baseline pain was 50.2.
• At 6 months, partial tear groups showed a 52.2% improvement, with pain reduced to 26.2.
• At 1 year, pain decreased by 55.4% to 22.4.
• At 2 years, pain decreased by 63.7% to 18.2.
• For the tendonitis group, improvements were observed at each follow-up but were not statistically significant.
• Patient Improvement:
• At 6 months, 77.9% of patients showed improvement in both disability and pain scores.
• At 1 year, 71.6% improved, and at 2 years, 68.8% showed improvement.
• Patients with a greater than 50% tear had the best outcomes, with 88.9% showing improvement at 6 months, 83.3% at 1 year, and 88.9% at 2 years. These patients had the most dramatic response to the treatment.
Risks and Side Effects
• No infections or serious adverse effects were reported in any patients receiving dual-injection PRP.
• Most patients experienced moderate soreness that resolved within a week.
• No symptoms indicated the progression of the tear, and no patients showed signs of further tendon damage.
Conclusion
The dual injection PRP technique offers a safe and effective treatment for patients with partial rotator cuff injuries who have failed conservative treatment. The technique resulted in significant improvements in disability and pain scores over 2 years, particularly in patients with torn tendons, who usually face surgical recommendations. This approach helps avoid the risks associated with surgery and provides a promising non-invasive alternative for rotator cuff injuries.
Reference:
Prodromos, C.C., Finkle, S., Prodromos, A., et al. (2021). Treatment of rotator cuff tears with platelet-rich plasma: A prospective study with a 2-year follow-up. BMC Musculoskeletal Disorders, 22:499.
