Clinical and radiological effects of platelet-rich plasma on interstitial supraspinatus lesion: A randomized, double-blind, controlled trial

Abstract

Aim To assess effectiveness of ultra-sound guided platelet-rich plasma infiltrations (PRP) on the supraspinatus interstitial tear healing. Background Symptomatic interstitial superior rotator cuff tear management remains challenging, as conservative management is rarely fully effective, and surgical management requires a long recovery period of 6 months. PRP infiltration might thus represent a valuable alternative. Methods We conducted a randomized, double-blind, controlled trial involving 80 patients suffering from a symptomatic isolated supraspinatus tendon interstitial tear. Patients received two intratendinous injections separated by 1 month, of either PRP (n = 41) or saline solution (n = 39). The primary outcome was tear size evolution, measured on magnetic-resonance arthrogram performed at baseline and at month 7. Results The tendon tear volume did not change between groups : 0 mm3 (range : −84 to +41) for PRP group and 9.8 mm3 (range : −264 to +270 mm3) for saline group (P = 0.175). Comparison between baseline and month 7 on the whole cohort showed a statistically significant decrease in median lesion size from 29 mm3 (range : 4–301) to 19 mm3 (range : 0–292) (P = 0.0293), and a significant improvement for all the clinical scores (VAS, SANE, Constant, and ASES scores) (P > 0.001). There were no between-group significant differences with respect to the clinical scores evolution. Main side effects identified were present on 26/80 patients (PRP : 18/41 ; control : 8/39 ; P = 0.0256), and consisted of : significant pain following injections (PRP : 11/41 ; control : 6/39), frozen shoulder (PRP : 8/41 ; control : 3/39), development of bursal- or articular-tear pattern at month 7 (PRP : 4/41 ; control : 1/39). Nine patients had to benefit a surgical rotator cuff repair after month 7 (PRP : 7/41 ; control : 2/40 ; P = 0.182). Conclusions PRP was not superior to saline injection regarding supraspinatus interstitial tear healing and clinical outcomes improvement. We observed a clinical and radiological improvement on the merged PRP and placebo groups between months 0 and 7. More side effects were observed on the PRP group. The potential costs of two PRP infiltrations are estimated as EURO 1100.