Application of PRP for Rotator Cuff Injuries
What is rotator cuff injury?
The rotator cuff muscles include:subscapularis, supraspinatus, infraspinatus, and teres minor. Shaped like a cuff, it wraps around the front, top and back of the shoulder joints. These four tendons surround the shoulder joint and form a sleeve-like structure, which is vividly called the rotator cuff. When these tissues are damaged, it is the rotator cuff injury.
Features of rotator cuff injuries
Rotator cuff injuries are common in people over the age of 40, and the prevalence increases with age. It accounts for about 30% of the elderly over the age of 60, and accounts for about 60% of the elderly over the age of 80. Most rotator cuff injuries are caused by indirect violence. For example, when we fall down, we use our hands to support the ground, when the outside of the arm resists the impact, when we encounter a sudden brake while driving, or when the dog is suddenly pulled by the dog while walking, rotator cuff injuries may occur. On the other hand, with age, rotator cuff degeneration can also occur, and long-term excessive use of the shoulder can lead to rotator cuff damage.
How to Differentiate Frozen Shoulder and Rotator Cuff Injuries
1. Different causes
Rotator cuff injury: Most patients have a history of shoulder trauma, and some patients have a history of shoulder joint fatigue.
Frozen shoulder: Generally, there is no history of trauma, and the exact cause is unknown.
2. Different clinical manifestations
Rotator cuff injury: After the occurrence, the main manifestations are shoulder joint pain and weakness. The patient has pain and weakness when lifting the shoulder abducted.
Frozen shoulder: Pain occurs gradually, progressively aggravated, often at night, and limited joint movement is the main manifestation. Both active and passive activities are obviously limited, and shoulder strength is generally normal.
PRP Therapy for Rotator Cuff Injuries
Treatment depends on the severity of the tear. Traditional conservative treatments aim to reduce pain and increase mobility with physical therapy and hyaluronic acid injections. Surgery is recommended if there is dysfunction, a full-thickness tear greater than 1 cm2, or if symptoms persist for more than one year. Results were generally favorable for patients choosing surgical options, including minimally invasive arthroscopic surgery, minimally invasive surgery, and open repair surgery. However, postoperative complications occurred in 38% of patients, and the rate of rerupture could be as high as 68%.
Emerging regenerative therapies create supraphysiological conditions within the joint to reduce downtime and rerupture rates. Injection of platelet-rich plasma at the site of rupture increases local growth factors that amplify tissue regeneration. Platelets circulate in the blood at about 150,000 to 450,000 platelets per microliter. Commercially available PRP preparations concentrate platelet levels 6-7-fold by differential centrifugation. If this concentration of platelets is injected at the site of injury, the damaged tissue benefits from the release of biologically active proteins called growth factors. Growth factors initiate wound healing by signaling to local cells. Some of the essential growth factors include: platelet-derived growth factor (PDGF) to regulate collagen synthesis, transforming growth factor (TGF);
Clinical evidence supporting the use of PRP injections includes a 2017 case series in which 19 patients had partial-thickness rotator cuff tears. Patients received a single injection of PRP centrifuged from a total of 20 mL of whole blood. The final formulation is injected into the subacromial capsule and intra-articular space. Patients were instructed to complete home exercises and stretches and then followed up for 3 months. The researchers found significant improvements in range of motion, pain and function in all patients. The results should be validated in larger placebo-controlled trials.
Level I evidence supports the adjunctive use of PRP during arthroscopic surgery for full-thickness tears. The same surgeon performed all procedures on the 53 patients participating in this randomized, double-blind, controlled trial. Twenty-six patients in the treatment group received a 54-mL blood draw and 6 mL of PRP was drawn. Platelet-rich plasma solution was clotted with autologous thrombin and applied to the dry subacromial space after arthroscopy. The researchers found that at 3 months, patients who received RPR were significantly different from those in the control group in all measured clinical outcomes. Subjective and objective measurements showed that due to the addition of PRP.
1.Clement ND, Nie YX, McBirnie JM. Management of degenerative rotator cuff tears: a review and treatment strategy. Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology: SMARTT. 2012;4:48. doi:10.1186/1758-2555-4-48.
2.Dhurat R, Sukesh M. Principles and Methods of Preparation of Platelet-Rich Plasma: A Review and Author’s Perspective. Journal of Cutaneous and Aesthetic Surgery. 2014;7(4):189-197. doi:10.4103/0974-2077.150734.
3.Zafarani Z, Mirzaee F, Guity M, Aslani H. Clinical Results of Platelet-Rich Plasma for Partial Thickness Rotator Cuff Tears: A Case Series. Archives of Bone and Joint Surgery. 2017;5(5):328-331.
4.Randelli P, Arrigoni P, Ragone V, Aliprandi A, Cabitza P. Platelet rich plasma in arthroscopic rotator cuff repair: a prospective RCT study, 2-year follow-up. J Shoulder Elbow Surg. 2011;20(4):518-28.