Platelet-rich plasma provides modest but durable functional benefit over corticosteroid for rotator cuff tendinopathy: A systematic review and meta-analysis of randomized controlled trials.

Abstract

To compare platelet-rich plasma (PRP) and corticosteroid (CS) injections in rotator cuff tendinopathy and partial-thickness tears. A systematic review was conducted. Eligible studies were randomized controlled trials (RCTs) of adults (≥18 years) with rotator cuff tendinopathy or partial tears comparing PRP with CS injections. Primary outcomes were pain, patient-reported outcome scores and adverse events. Random-effects meta-analyses were performed using mean difference (MD) or risk ratio (RR) with 95% confidence intervals (CIs). Ten RCTs (n = 591) were included. At 3- to 6-week and 3-month follow-up, pain and patient-reported outcomes did not differ significantly between groups. At 6 months, PRP demonstrated clearer benefits. PRP improved American Shoulder and Elbow Surgeons score (ASES) (MD + 10.8, 95% CI: 4.71-16.80, p = 0.0005) and Constant-Murley score (CMS) (MD + 10.7, 95% CI: 1.21-20.27, p = 0.027). Pain reduction at 6 months favoured PRP (pain visual analogue scale [VAS] MD -0.8, 95% CI: -1.45 to -0.18, p = 0.012). PRP was associated with fewer adverse events (RR 0.66, 95% CI: 0.44-0.99, p = 0.047). PRP injections offer statistically significant, although clinically modest, improvements in pain and shoulder function compared with CS injections and are associated with fewer adverse events at 6 months. Taken together, these findings suggest that PRP may serve as a more durable treatment option for patients with rotator cuff tendinopathy. Level I.