Platelet-Rich Plasma for Torn or Degenerated Rotator Cuffs?

The Regenexx Stem Cell Blog reports on a study that shows that platelet rich plasma (PRP) injections into torn rotator cuffs is better than placebo.

PRP has been used by the Centeno clinic and several others to treat knee and foot  injuries, but there is less known about the efficacy of PRP on rotator cuffs. In this study patients with rotator cuff problems in both shoulders were given dry needle injections on one side and PRP on the other. The PRP shoulders showed noticeable improvement whereas the dry injected shoulders did not.

Centeno has been using PRP for knee treatments for several years and with some success. If this treatment can also work for shoulders, then this will certainly augment the possible treatment options for patients with rotator cuff injuries.

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Professor of Biochemistry at Spring Arbor University (SAU) in Spring Arbor, MI. Have been at SAU since 1999. Author of The Stem Cell Epistles. Before that I was a postdoctoral research fellow at the University of Pennsylvania in Philadelphia, PA (1997-1999), and Sussex University, Falmer, UK (1994-1997). I studied Cell and Developmental Biology at UC Irvine (PhD 1994), and Microbiology at UC Davis (MA 1986, BS 1984).

2 thoughts on “Platelet-Rich Plasma for Torn or Degenerated Rotator Cuffs?”

  1. This doesn’t actually seem very promising to me. From the abstract’s silence on the subject, it seems that there were no significant advantages to PRP over placebo in any of the objective outcomes: passive range of motion, physician global rating scale , or ultrasound measurement. It’s also not clear if the study was blinded: I imagine that it would’ve been to the patients, but it isn’t clear what the clinicians knew. If PRP only improves subjective pain and self-rated disability, it may just be a placebo effect — and, if not, it certainly won’t be a dramatic therapeutic advance, although a near-halving of subjective problems does seem favorable.

  2. I will grant you that the lack of structural improvements documented by imaging detracts from the paper’s conclusions, but there was a significant decrease in the Shoulder Pain and Disability Index. From my reading of the paper, it seems that the study was properly blinded.

    On his blog, Centeno constantly emphasizes that MRIs are potentially misleading, because a joint in many patients can look awful on imagining, but the patient has little to no pain. Conversely, some patients have normal joints on imagining, but still have significant pain. Therefore, in Centeno’s eyes, the reduction of pain is a significant finding, because the pain a patient experiences will cause them to misuse the joint and subject it to further adaptive movements that place eccentric force on the joint and reinforce the injury. Relieving pain will allow the patient to use the joint properly and relieve some of the eccentric forces on the joint created by the injury.

    I doubt that the reduction in pain and disability was solely due to the placebo effect, because the dry needling should have provided an equal reduction and it did not.

    Therefore, I would say that, according to this study PRP injections result in a modest improvement; albeit an improvement only in subjective and self-reported measurements.

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