Comparison of the therapeutic effects of ultrasound-guided platelet-rich plasma injection and dry needling in rotator cuff disease: a randomized controlled trial. Clin Rehabil

1Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, South Korea.
Clinical Rehabilitation (Impact Factor: 2.24). 10/2012; 27(2). DOI: 10.1177/0269215512448388
Source: PubMed

ABSTRACT Objective:To compare the effects of platelet-rich plasma injection with those of dry needling on shoulder pain and function in patients with rotator cuff disease.Design:A single-centre, prospective, randomized, double-blinded, controlled study.Setting:University rehabilitation hospital.Participants:Thirty-nine patients with a supraspinatus tendon lesion (tendinosis or a partial tear less than 1.0 cm, but not a complete tear) who met the inclusion criteria recruited between June 2010 and February 2011.Intervention:Two dry needling procedures in the control group and two platelet-rich plasma injections in the experimental group were applied to the affected shoulder at four-week intervals using ultrasound guidance.Measurements:The Shoulder Pain and Disability Index, passive range of motion of the shoulder, a physician global rating scale at the six-month follow-up, adverse effects monitoring and an ultrasound measurement were used as outcome measures.Results:The clinical effect of the platelet-rich plasma injection was superior to the dry needling from six weeks to six months after initial injection (P < 0.05). At six months the mean Shoulder Pain and Disability Index was 17.7 ± 3.7 in the platelet-rich plasma group versus 29.5 ± 3.8 in the dry needling group (P < 0.05). No severe adverse effects were observed in either group.Conclusions:Autologous platelet-rich plasma injections lead to a progressive reduction in the pain and disability when compared to dry needling. This benefit is certainly still present at six months after treatment. These findings suggest that treatment with platelet-rich plasma injections is safe and useful for rotator cuff disease.

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Available from: Gi-young Park, Oct 14, 2014
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    • "In spite of this popularity and increasing use in clinical settings we have found only two controlled randomized trials evaluating the use of PRP injections in rotator cuff tendinopathy [19, 20]. "
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    ABSTRACT: Rotator cuff injuries are a common source of shoulder pathology and result in an important decrease in quality of patient life. Given the frequency of these injuries, as well as the relatively poor result of surgical intervention, it is not surprising that new and innovative strategies like tissue engineering have become more appealing. Tissue-engineering strategies involve the use of cells and/or bioactive factors to promote tendon regeneration via natural processes. The ability of numerous growth factors to affect tendon healing has been extensively analyzed in vitro and in animal models, showing promising results. Platelet-rich plasma (PRP) is a whole blood fraction which contains several growth factors. Controlled clinical studies using different autologous PRP formulations have provided controversial results. However, favourable structural healing rates have been observed for surgical repair of small and medium rotator cuff tears. Cell-based approaches have also been suggested to enhance tendon healing. Bone marrow is a well known source of mesenchymal stem cells (MSCs). Recently, ex vivo human studies have isolated and cultured distinct populations of MSCs from rotator cuff tendons, long head of the biceps tendon, subacromial bursa, and glenohumeral synovia. Stem cells therapies represent a novel frontier in the management of rotator cuff disease that required further basic and clinical research.
    BioMed Research International 08/2014; 2014:129515. DOI:10.1155/2014/129515 · 3.17 Impact Factor
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    • "Platelet-rich plasma in tendinopathy, 2014, Vol. 110 107 Table 3 Risk of bias assessment Creaney 2011 27 De Vos 2010 28 Dragoo 2014 30 Filardo 2012 31 Kesikburun 2013 32 Krogh 2013 33 Mishra 2013 34 Omar 2012 35 Peerbooms 2010 36 Raeissadat 2014 38 Rha 2012 39 Thanasas 2011 40 Vetrano 2013 41 "
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    ABSTRACT: Background Platelet-rich plasma (PRP) seeks to meet the multifaceted demand of degenerated tendons providing several molecules capable of boosting healing.Areas timely for developing researchPRP is used for managing tendinopathy, but its efficacy is controversial.Sources of dataElectronic databases were searched for clinical studies assessing PRP efficacy. Methodological quality was evaluated using the methods described in the Cochrane Handbook for systematic reviews.Areas of agreementThirteen prospective controlled studies, comprising 886 patients and diverse tendons were included; 53.8% of studies used identical PRP protocol.Areas of controversySources of heterogeneity included different comparators, outcome scores, follow-up periods and diverse injection protocols, but not PRP formulation per se.Growing pointsPooling pain outcomes over time and across different tendons showed that L-PRP injections ameliorated pain in the intermediate-long term compared with control interventions, weighted mean difference (95% CI): 3 months, -0.61 (-0.97, -0.25); 1 year, -1.56 (-2.27, -0.83). However, these findings cannot be applied to the management of individual patients given low power and precision.ResearchFurther studies circumventing heterogeneity are needed to reach firm conclusions. Available evidence can help to overcome hurdles to future clinical research and bring forward PRP therapies.
    British Medical Bulletin 05/2014; 110(1). DOI:10.1093/bmb/ldu007 · 3.66 Impact Factor
    • "It is important to note that the distal part of the rotator tendon has inherently poor healing capabilities; PRP with its growth factors may thus be an attractive option for the stimulation of the healing of this tendon. Many shoulder surgeons have started using PRP intraoperatively after performing rotator cuff repairs.353637 "
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    ABSTRACT: Orthobiologics have evolved to the extent that they significantly influence modern orthopedic surgical practice. A better understanding of the role of various growth factors and cells in the process of tendon healing, ligament repair, cartilage regeneration and bone formation has stimulated focused research in many chronic musculoskeletal ailments. Investigators have published results of laboratory as well as clinical studies, using orthobiologics like platelet rich plasma, stem cells, autologous conditioned serum etc., with variable results. However, a clear consensus over the best orthobiologic substance and the method of preparation and usage of these substances is lacking. Much of the confusion is due to the fact that studies ranging from RCTs to case reports present variable results, and the interpretations are wide-ranging. We have reviewed the available orthobiologics related data with a focus on platelet rich plasma in orthopedic conditions.
    Indian Journal of Orthopaedics 03/2014; 48(1):1-9. DOI:10.4103/0019-5413.125477 · 0.64 Impact Factor
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