Skip to main content
SpringerLink
Log in

The effect of subacromial injections of autologous conditioned plasma versus cortisone for the treatment of symptomatic partial rotator cuff tears

  • Shoulder
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Rotator cuff tears are one of the most common causes of shoulder malfunction and pain, which lead to a significant reduction in the quality of life. This present study investigated the effects of subacromial platelet-rich plasma injections [i.e. autologous conditioned plasma (ACP) injections] as compared to standard subacromial cortisone injection therapy in 50 patients with partial rotator cuff tears.

Methods

Before injection, and 6 weeks, 12 weeks and 6 months thereafter, the patients were assessed by the Constant–Murley score (CMS), the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), the simple shoulder test (SST) and a pain visual analogue scale (VAS). An MRI was also performed before and 6 months after injection.

Results

Both patient groups had statistically significant better shoulder score outcomes over time. ASES, SST and CMS outcomes after 12 versus 6 weeks were better in the ACP group as compared to the cortisone group. VAS, ASES and CMS outcomes after 12 weeks versus baseline in the ACP group were better as compared to the cortisone group. There was a statistically significant difference between ACP group and cortisone group 12 weeks after injection regarding VAS, ASES, SST and CMS in favour of the ACP group. The MRI showed an improvement in grade of tendinopathy in both groups, however, without statistically significant differences between the two groups.

Conclusion

Compared with cortisone injections, ACP injections show earlier benefit as compared to cortisone injections although a statistically significant difference after 6 months could not be found. Therefore, subacromial ACP injections are a good alternative to subacromial cortisone injections, especially in patients with contraindication to cortisone.

Level of evidence

Therapeutic study, Level III.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Antuna S, Barco R, Martinez Diez JM, Sanchez Marquez JM (2013) Platelet-rich fibrin in arthroscopic repair of massive rotator cuff tears: a prospective randomized pilot clinical trial. Acta Orthop Belg 79(1):25–30

    PubMed  Google Scholar 

  2. Barber FA, Hrnack SA, Snyder SJ, Hapa O (2011) Rotator cuff repair healing influenced by platelet-rich plasma construct augmentation. Arthroscopy 27(8):1029–1035

    Article  PubMed  Google Scholar 

  3. Bergeson AG, Tashjian RZ, Greis PE, Crim J, Stoddard GJ, Burks RT (2012) Effects of platelet-rich fibrin matrix on repair integrity of at-risk rotator cuff tears. Am J Sports Med 40(2):286–293

    Article  PubMed  Google Scholar 

  4. Bosch G, Moleman M, Barneveld A, van Weeren PR, van Schie HT (2011) The effect of platelet-rich plasma on the neovascularization of surgically created equine superficial digital flexor tendon lesions. Scand J Med Sci Sports 21(4):554–561

    Article  CAS  PubMed  Google Scholar 

  5. Castricini R, Longo UG, De BM et al (2011) Platelet-rich plasma augmentation for arthroscopic rotator cuff repair: a randomized controlled trial. Am J Sports Med 39(2):258–265

    Article  PubMed  Google Scholar 

  6. Cervellin M, de Girolamo L, Bait C, Denti M, Volpi P (2012) Autologous platelet-rich plasma gel to reduce donor-site morbidity after patellar tendon graft harvesting for anterior cruciate ligament reconstruction: a randomized, controlled clinical study. Knee Surg Sports Traumatol Arthrosc 20(1):114–120

    Article  CAS  PubMed  Google Scholar 

  7. Chahal J, Van Thiel GS, Mall N et al (2012) The role of platelet-rich plasma in arthroscopic rotator cuff repair: a systematic review with quantitative synthesis. Arthroscopy 28(11):1718–1727

    Article  PubMed  Google Scholar 

  8. Charousset C, Zaoui A, Bellaiche L, Piterman M (2014) Does autologous leukocyte-platelet-rich plasma improve tendon healing in arthroscopic repair of large or massive rotator cuff tears? Arthroscopy 30(4):428–435

    Article  PubMed  Google Scholar 

  9. Constant CR, Murley AG (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164

    Google Scholar 

  10. Cook JL, Purdam CR (2009) Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. Br J Sports Med 43(6):409–416

    Article  CAS  PubMed  Google Scholar 

  11. Creaney L, Hamilton B (2008) Growth factor delivery methods in the management of sports injuries: the state of play. Br J Sports Med 42(5):314–320

    Article  CAS  PubMed  Google Scholar 

  12. de Mos M, van der Windt AE, Jahr H et al (2008) Can platelet-rich plasma enhance tendon repair? A cell culture study. Am J Sports Med 36(6):1171–1178

    Article  PubMed  Google Scholar 

  13. de Vos RJ, Weir A, van Schie HT et al (2010) Platelet-rich plasma injection for chronic Achilles tendinopathy: a randomized controlled trial. JAMA 303(2):144–149

    Article  PubMed  Google Scholar 

  14. Dhillon MS, Behera P, Patel S, Shetty V (2014) Orthobiologics and platelet rich plasma. Indian J Orthop 48(1):1–9

    Article  PubMed  PubMed Central  Google Scholar 

  15. Everts PA, Devilee RJ, Brown MC et al (2008) Exogenous application of platelet-leukocyte gel during open subacromial decompression contributes to improved patient outcome. A prospective randomized double-blind study. Eur Surg Res 40(2):203–210

    Article  CAS  PubMed  Google Scholar 

  16. Gumina S, Campagna V, Ferrazza G et al (2012) Use of platelet-leukocyte membrane in arthroscopic repair of large rotator cuff tears: a prospective randomized study. J Bone Joint Surg Am 94(15):1345–1352

    Article  PubMed  Google Scholar 

  17. Hansen M, Boesen A, Holm L, Flyvbjerg A, Langberg H, Kjaer M (2013) Local administration of insulin-like growth factor-I (IGF-I) stimulates tendon collagen synthesis in humans. Scand J Med Sci Sports 23(5):614–619

    CAS  PubMed  Google Scholar 

  18. Haraldsson BT, Langberg H, Aagaard P, Zuurmond AM, van El B, Degroot J, Kjaer M, Magnusson SP (2006) Corticosteroids reduce the tensile strength of isolated collagen fascicles. Am J Sports Med 34(12):1992–1997

    Article  PubMed  Google Scholar 

  19. Heisterbach PE, Todorov A, Fluckiger R, Evans CH, Majewski M (2012) Effect of BMP-12, TGF-beta1 and autologous conditioned serum on growth factor expression in Achilles tendon healing. Knee Surg Sports Traumatol Arthrosc 20(10):1907–1914

    Article  PubMed  Google Scholar 

  20. Ho JO, Sawadkar P, Mudera V (2014) A review on the use of cell therapy in the treatment of tendon disease and injuries. J Tissue Eng 18(5):2041731414549678

    Google Scholar 

  21. Ide J, Kikukawa K, Hirose J et al (2009) The effect of a local application of fibroblast growth factor-2 on tendon-to-bone remodeling in rats with acute injury and repair of the supraspinatus tendon. J Shoulder Elbow Surg 18(3):391–398

    Article  PubMed  Google Scholar 

  22. Jo CH, Kim JE, Yoon KS et al (2011) Does platelet-rich plasma accelerate recovery after rotator cuff repair? A prospective cohort study. Am J Sports Med 39(10):2082–2090

    Article  PubMed  Google Scholar 

  23. Jo CH, Shin JS, Lee YG et al (2013) Platelet-rich plasma for arthroscopic repair of large to massive rotator cuff tears: a randomized, single-blind, parallel-group trial. Am J Sports Med 41(10):2240–2248

    Article  PubMed  Google Scholar 

  24. Kaux JF, Janssen L, Drion P et al (2014) Vascular Endothelial Growth Factor-111 (VEGF-111) and tendon healing: preliminary results in a rat model of tendon injury. Muscles Ligaments Tendons J 4(1):24–28

    PubMed  PubMed Central  Google Scholar 

  25. Kesikburun S, Tan AK, Yilmaz B, Yasar E, Yazicioglu K (2013) Platelet-rich plasma injections in the treatment of chronic rotator cuff tendinopathy: a randomized controlled trial with 1-year follow-up. Am J Sports Med 41(11):2609–2616

    Article  PubMed  Google Scholar 

  26. Lewis JS (2010) Rotator cuff tendinopathy: a model for the continuum of pathology and related management. Br J Sports Med 44(13):918–923

    Article  PubMed  Google Scholar 

  27. Lippitt SB, Harryman DT, Matsen FA, Fu FH, Hawkins RJ (1993) A practical tool for evaluating function: the simple shoulder test. In: Matsen F (ed) The shoulder: a balance of mobility and stability, American Academy of Orthopaedic Surgeons, pp 501–518

  28. Malavolta EA, Gracitelli ME, Ferreira Neto AA, Assuncao JH, Bordalo-Rodrigues M, de Camargo OP (2014) Platelet-rich plasma in rotator cuff repair: a prospective randomized study. Am J Sports Med 42(10):2446–24154

    Article  PubMed  Google Scholar 

  29. Molini L, Mariacher S, Bianchi S (2012) US guided corticosteroid injection into the subacromial-subdeltoid bursa: technique and approach. J Ultrasound 15(1):61–68

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Nguyen RT, Borg-Stein J, McInnis K (2011) Applications of platelet-rich plasma in musculoskeletal and sports medicine: an evidence-based approach. PM R 3(3):226–250

    Article  PubMed  Google Scholar 

  31. Oh JH, Jo KH, Kim WS, Gong HS, Han SG, Kim YH (2009) Comparative evaluation of the measurement properties of various shoulder outcome instruments. Am J Sports Med 37(6):1161–1168

    Article  PubMed  Google Scholar 

  32. Peerbooms JC, Sluimer J, Bruijn DJ, Gosens T (2010) Positive effect of an autologous platelet concentrate in lateral epicondylitis in a double-blind randomized controlled trial: platelet-rich plasma versus corticosteroid injection with a 1-year follow-up. Am J Sports Med 38(2):255–262

    Article  PubMed  Google Scholar 

  33. Randelli PS, Arrigoni P, Cabitza P, Volpi P, Maffulli N (2008) Autologous platelet rich plasma for arthroscopic rotator cuff repair. A pilot study. Disabil Rehabil 30(20–22):1584–1589

    Article  PubMed  Google Scholar 

  34. Randelli P, Arrigoni P, Ragone V, Aliprandi A, Cabitza P (2011) Platelet rich plasma in arthroscopic rotator cuff repair: a prospective RCT study, 2-year follow-up. J Shoulder Elbow Surg 20(4):518–528

    Article  PubMed  Google Scholar 

  35. Rha DW, Park GY, Kim YK, Kim MT, Lee SC (2013) 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 27(2):113–122

    Article  PubMed  Google Scholar 

  36. Richards RR, An KN, Bigliani LU et al (1994) A standardized method for the assessment of shoulder function. J Shoulder Elbow Surg 3(6):347–352

    Article  CAS  PubMed  Google Scholar 

  37. Rickert M, Wang H, Wieloch P et al (2005) Adenovirus-mediated gene transfer of growth and differentiation factor-5 into tenocytes and the healing rat Achilles tendon. Connect Tissue Res 46(4–5):175–183

    Article  CAS  PubMed  Google Scholar 

  38. Rocourt MH, Radlinger L, Kalberer F, Sanavi S, Schmid NS, Leunig M, Hertel R (2008) Evaluation of intratester and intertester reliability of the Constant–Murley shoulder assessment. J Shoulder Elbow Surg 17(2):364–369

    Article  PubMed  Google Scholar 

  39. Rodeo SA, Delos D, Williams RJ, Adler RS, Pearle A, Warren RF (2012) The effect of platelet-rich fibrin matrix on rotator cuff tendon healing: a prospective, randomized clinical study. Am J Sports Med 40(6):1234–1241

    Article  PubMed  Google Scholar 

  40. Ruiz-Moneo P, Molano-Munoz J, Prieto E, Algorta J (2013) Plasma rich in growth factors in arthroscopic rotator cuff repair: a randomized, double-blind, controlled clinical trial. Arthroscopy 29(1):2–9

    Article  PubMed  Google Scholar 

  41. Rutgers M, Saris DB, Dhert WJ, Creemers LB (2010) Cytokine profile of autologous conditioned serum for treatment of osteoarthritis, in vitro effects on cartilage metabolism and intra-articular levels after injection. Arthritis Res Ther 12(3):R114

    Article  PubMed  PubMed Central  Google Scholar 

  42. Scarpone M, Rabago D, Snell E et al (2013) Effectiveness of platelet-rich plasma injection for rotator cuff tendinopathy: a prospective open-label study. Glob Adv Health Med 2(2):26–31

    Article  PubMed  PubMed Central  Google Scholar 

  43. Schnabel LV, Mohammed HO, Miller BJ et al (2007) Platelet rich plasma (PRP) enhances anabolic gene expression patterns in flexor digitorum superficialis tendons. J Orthop Res 25(2):230–240

    Article  CAS  PubMed  Google Scholar 

  44. Suwalski A, Dabboue H, Delalande A et al (2010) Accelerated Achilles tendon healing by PDGF gene delivery with mesoporous silica nanoparticles. Biomaterials 31(19):5237–5245

    Article  CAS  PubMed  Google Scholar 

  45. Weber SC, Kauffman JI, Parise C, Weber SJ, Katz SD (2013) Platelet-rich fibrin matrix in the management of arthroscopic repair of the rotator cuff: a prospective, randomized, double-blinded study. Am J Sports Med 41(2):263–270

    Article  PubMed  Google Scholar 

  46. Zavadil DP, Satterlee CC, Costigan JM, Holt DW, Shostrom VK (2007) Autologous platelet gel and platelet-poor plasma reduce pain with total shoulder arthroplasty. J Extra Corpor Technol 39(3):177–182

    PubMed  PubMed Central  Google Scholar 

  47. Zhang Q, Ge H, Zhou J, Cheng B (2013) Are platelet-rich products necessary during the arthroscopic repair of full-thickness rotator cuff tears: a meta-analysis. PLoS One 8(7):e69731

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Zheng XQ, Li K, Wei YD, Tie HT, Yi XY, Huang W (2014) Nonsteroidal anti-inflammatory drugs versus corticosteroid for treatment of shoulder pain: a systematic review and meta-analysis. Arch Phys Med Rehabil 95(10):1824–1831

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We gratefully acknowledge the help of Dr. Rolf Pokorny for proofreading.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Orthopädie, Universitätsspital Basel, Spitalstrasse 21, 4031, Basel, Switzerland

    Lutz von Wehren, Atanas Todorov, Patricia Heisterbach, Jannis Sailer & Martin Majewski

  2. Klinik für Sportorthopädie und arthroskopische Chirurgie, Orthopädische Fachkliniken der Hessingstiftung, Hessingstrasse 17, 86199, Augsburg, Germany

    Fabian Blanke

Authors
  1. Lutz von Wehren
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fabian Blanke
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Atanas Todorov
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Patricia Heisterbach
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jannis Sailer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Martin Majewski
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Martin Majewski.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

von Wehren, L., Blanke, F., Todorov, A. et al. The effect of subacromial injections of autologous conditioned plasma versus cortisone for the treatment of symptomatic partial rotator cuff tears. Knee Surg Sports Traumatol Arthrosc 24, 3787–3792 (2016). https://doi.org/10.1007/s00167-015-3651-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-015-3651-3

Keywords

Search

Navigation