Comparison of the effectiveness of subacromial administration of platelet-rich plasma and hyaluronic acid in chronic shoulder pain caused by damage to the tendons of the rotator cuff muscles according to a 6-month open clinical study

Abstract

Local injections of platelet-rich plasma (PRP) and hyaluronic acid (HLA) are considered an effective method for treating chronic shoulder pain (CSP) associated with damage to the tendons of the rotator cuff muscles (RCM).The aim of the study is to compare the effectiveness and safety of local therapy of PRP and HLA in patients with CSP caused by damage to the tendons of the RCM muscles.Materials and methods. The study included 100 patients (54% women and 46% men, average age 51.5±15.1 years) with CSP (persisting for ≥3 months) associated with damage and tendinitis of the supraspinatus, subacute, scapular or small round muscle, confirmed by magnetic resonance imaging or ultrasound (ultrasound). The patients were randomized into two groups of 50 people who were treated with PRP (three injections at 7-day intervals) or HLA (two injections at 7-day intervals). The injections were performed under ultrasound control in the subacromial SAC. The results of the study were evaluated by the dynamics of pain intensity (on a visual analog scale, up to 100 mm) and functional disorders (ASES and CSS indices) after 1, 3 and 6 months.Results. Against the background of the use of PRP and HLA, there was a significant improvement in the condition of patients, while both drugs showed approximately the same effectiveness. The severity of VAS pain decreased from 56.8±15, respectively, after 6 months.5 and 57.6±17.8 mm to 31.8±27.8 and 30.2±26.3 mm, ASES-c 55.8±15.9 and 53.6±14.7 to 74.6±22.4 and 77.3± 22.4, CSS-c 59.2±14.4 and 47.8±16.9 to 69.9±17.3 and 65.6±19.2. the Dynamics of all these indicators in comparison with the baseline level was statistically significant (p<0.001). Number of patients with moderate / mild pain (<40 mm VAS) after 6 months. after the introduction of PRP and HLA was 48% and 60%, requiring regular NSAID intake 30% and 28%, respectively. In all parameters, the difference in the effectiveness of PRP and HLC was not statistically significant (p>0.05). The effectiveness of PRP and HLA (in terms of pain dynamics, ASES, and CSS) was significantly higher in individuals younger than 45 years, compared to older patients. The tolerability of therapy was good – after the introduction of PRP, 40% of patients had a short-term (3–4 days) increase in pain, which did not require the use of additional analgesics or interruption of treatment. No serious adverse reactions were observed when using PRP and HLA.Conclusion. OTP and GLA are effective and safe in the treatment of CSP associated with damage to the tendons of the RCM muscles. The dynamics of pain intensity and functional status after the use of these drugs did not differ. Treatment of PRP and HLA is more effective in people younger than 45 years.