What is better for rotator cuff tendinopathy: dextrose prolotherapy, platelet-rich plasma, or corticosteroid injections? A randomized controlled study

Abstract

Background Rotator cuff tendinopathy (RCT) is a leading cause of shoulder pain and disability. Management is mainly conservative, but the limited ability of tendons to regenerate is the main cause of unsatisfactory results. So, we conducted our study to compare the efficacy of deep prolotherapy (glucose 25%), platelet-rich plasma (PRP), and betamethasone corticosteroid for treatment of RCT to find the most effective one based on clinical, functional, and radiological assessment. Results Regarding visual analog scale (VAS), it was significantly (p < 0.001) improved after injection among group 1 (prolotherapy group) and group 3 (steroid group) patients, while no significant improvement was noted among group 2 (PRP group) (p = 0.212) patients. The Western Ontario Rotator Cuff (WORC) Index significantly improved among the studied groups (p < 0.001, p = 0.049, and p < 0.001, respectively) after injection. Regarding the range of motion (ROM), a significant improvement (p = 0.029) was achieved in group 1 after injection but no significant improvements were noted among group 2 and 3 patients (p = 0.529 and 0.121, respectively). There was a significant improvement among group 1 and 2 patients (p < 0.001 and p = 0.020, respectively) regarding the grade of tendon lesions but no improvement occurred among group 3 patients (p = 0.470). Conclusion Prolotherapy injections improve shoulder ROM, VAS, WORC index, and rotator cuff tendon healing while PRP injections improve WORC index and tendon healing but steroid injection has no effect on healing. Trial registration PACTR202005610509496. Retrospective registration on May 25, 2020, Pan African Clinical Trial Registry.

Platelet‐rich plasma versus corticosteroid injections in the management of patients with rotator cuff disease: A systematic review and meta‐analysis

“…The baseline VAS scores along with their change from base‐line can be found in Table 4 . At short‐ and intermediate‐term follow‐up, the change from baseline was comparable between the CS and PRP groups and no difference was observed (short‐term: MD = −0.30, 95% CI: −1.40, 0.08; p = 0.59; I 2 = 89% 12 , 26 , 28 , 32 , 34 ) (Intermediate‐term: MD = 0.28, 95% CI: −0.71, 1.28; p = 0.58; I 2 = 84% 26 , 27 , 28 , 31 , 32 ). At medium‐term follow‐up, no difference in the change of VAS score from base‐line was observed between the PRP and CS groups (MD = 0.39, 95% CI: −1.84, 2.62; p = 0.73; I 2 = 97% 12 , 28 , 32 , 34 ).…”

“…It has been demonstrated that an apheresis and buffy coat‐derived preparation achieved a higher platelet concentration owing to a possible extra centrifugation step, which in turn allows for higher growth factor levels, as opposed to a tube method preparation, which, on the other hand, showed the highest level of white blood cell contamination 55 . A handful of these studies utilized a similar protocol which involved a double centrifugation that gives rise to PRP derived from the upper plasma layer and the buffy coat (buffy‐coat derived) 25,30,31 . However, 12 prepared PRP manually using a single spin rotation.…”

“… 55 A handful of these studies utilized a similar protocol which involved a double centrifugation that gives rise to PRP derived from the upper plasma layer and the buffy coat (buffy‐coat derived). 25 , 30 , 31 However, 12 prepared PRP manually using a single spin rotation.…”

Platelet-rich plasma does not improve clinical results in patients with rotator cuff disorders but reduces the retear rate. A systematic review and meta-analysis

“…Sixteen studies [2, 4, 7, 11, 19–21, 25, 28, 35, 41, 43, 44, 46, 47, 54] compared conservative treatment using PRP injections vs corticosteroid (CS) (nine studies), saline (three), exercise (two), prolotherapy (two), physical therapy (one), dry needling (one), sodium hyaluronate (SH) (one), and lidocaine (one). Three of these studies had more than two groups: two studies had three arms (PRP, SH, and saline in one study; PRP, prolotherapy, and corticosteroids in the other); and one study had four arms (PRP, prolotherapy, corticosteroids, and lidocaine).…”

“…In this case, a meta‐analysis was not feasible due to the high heterogeneity of the included studies, nonetheless important findings could still be highlighted. With regard to functional outcomes, the majority of the retrieved studies reported conflicting results, with several advocating significant improvement over control (sometimes for just a few months), while others denied such a finding [2, 19, 25, 35, 43, 46]. These results are in line with the review of Lin et al [31], but are in contrast with the results of Xiang et al [61], who concluded in favour of statistical and clinical improvements in pain and function within 6 months of follow‐up.…”