Platelet-Rich Plasma and Rehabilitation for Upper Extremity Musculoskeletal Pathologies A Systematic Review with Meta-Analysis
Main Article Content
Keywords
Exercise, Platelet-Rich Plasma, Rehabilitation
Abstract
Background: Platelet-rich plasma (PRP) is considered in clinical practice for its role in facilitating the body’s own healing processes, with the potential to complement physical therapy in managing musculoskeletal pathologies of the upper extremity.
Methods: Eligible studies must be randomized with clinical/quasi-experimental trials with complete data analysis, and published in English. They have to recruit participants aged >18 years; have at least two groups, with one intervention group receiving PRP injection alone or PRP injection and rehabilitation, and the comparison group receiving either rehabilitation alone or a control group receiving saline and rehabilitation; and finally include at least one outcome measure of pain, disability, or quality of life. An electronic search was conducted using PubMed, Embase, Cochrane, Pedro, and clinicaltrials.gov. Methodological quality was assessed using the Cochrane Collaboration Risk of Bias (RoB) tool. The grading of recommendations assessment, development, and evaluation approach was used to provide an overall assessment of the quality of evidence. Meta-analyses were conducted across outcomes within each pathology when possible.
Results: A total of 13 studies assessing adhesive capsulitis, carpal tunnel syndrome, lateral epicondylal-gia, rotator cuff tendinopathy, subacromial impingement syndrome, and shoulder osteoarthritis were included with an average RoB score of 8.77 out of 12 across all studies. Meta-analyses for rotator cuff tendinopathy (n = 49) revealed a significant effect on pain (cm) (mean difference [MD] -2.53; 95% confidence interval [CI]: −5.02, −0.04; I2 statistic = 51%; P = 0.05), quality of life (MD 16.82; 95% CI: 0.40, 33.25; I2 = 0%; P = 0.04), and disability (standardized mean difference [SMD]: −0.64; 95% CI: −1.24, −0.04; I2 = 0%; P = 0.04) favoring PRP and physical therapy as long-term follow-up (moderate level of evidence). All other meta-analyses for adhesive capsulitis and carpal tunnel demonstrated nonsignificant effects.
Conclusions: This systematic review demonstrated that PRP is a beneficial adjunct to physical therapy for reducing pain and improving disability and quality of life (moderate level of evidence) when compared to placebo plus physical therapy for the management of rotator cuff tendinopathy.
References
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2. Dieleman JL, Templin T, Sadat N, Reidy P, Chapin A, Foreman K, et al. National spending on health by source for 184 countries between 2013 and 2040. Lancet. 2016;387(10037):2521-35. https://doi.org/10.1016/S0140-6736(16)30167-2.
3. Woolf AD, Pfleger B. Burden of major musculoskeletal conditions. Bull World Health Organ. 2003;81(9):646–56. https://www.ncbi.nlm.nih.gov/pubmed/14710506
4. Bachynsky N. Implications for policy: The triple aim, quadruple aim, and interprofessional collaboration. Nurs Forum. 2020;55(1):54–64. https://doi.org/10.1111/nuf.12382
5. Transparency Market Research. Platelet rich plasma (PRP) market (type—Pure platelet rich plasma (P-PRP), leukocyte platelet-rich plasma (L-PRP), and pure-platelet-rich fibrin (P-PRF); origin—Autologous, homologous, and allogeneic; application—Orthopedic surgery, neurosurgery, cosmetic surgery, general surgery, urological surgery, cardiothoracic surgery, and periodontal surgery—Global industry analysis, size, share, growth, trends and forecast 2016–2024 [Internet]. Albany, NY: TMR [cited 2016]. Available from: https://wwwtransparencymarketresearch.com/platelet-rich-plasma-market.html.
6. Kolber MJ, Purita J, Paulus C, Carreno JA, Hanney WJ. Platelet-rich plasma: Post-procedural considerations for the sports medicine professional. Strength Cond J. 2018;40:95–107.
7. Kolber MJ, Purita J, Paulus C, Carreno JA, Hanney WJ. Platelet-rich plasma: Basic science and biological effects. Strength Cond J. 2018;40:77–94.
8. Kolber MJ, Salamh PA. Platelet-rich plasma: Have we reached a consensus or understanding? Strength Cond J. 2019;41:81–6. https://doi.org/10.1519/SSC.0000000000000441
9. Dallari D, Tschon M, Sabbioni G, Giavaresi G. PRP and HA for hip osteoarthritis: response. Am J Sports Med. 2016;44(9):NP44–6. https://doi.org/10.1177/0363546516663692
10. Kothari SY, Srikumar V, Singh N. Comparative efficacy of platelet rich plasma injection, corticosteroid injection and ultrasonic therapy in the treatment of periarthritis shoulder. J Clin Diagn Res. 2017;11(5):RC15–18. https://doi.org/10.7860/JCDR/2017/17060.9895
11. Shen L, Yuan T, Chen S, Xie X, Zhang C. The temporal effect of platelet-rich plasma on pain and physical function in the treatment of knee osteoarthritis: Systematic review and meta-analysis of randomized controlled trials. J Orthop Surg Res. 2017;12(1):16. https://doi.org/10.1186/s13018-017-0521-3
12. Robins R. Platelet-rich plasma: Current indications and use in orthopaedic care. Med Res Arch. 2017;5(6):1–17.
13. Navani A, Li G, Chrystal J. Platelet rich plasma in musculoskeletal pathology: A necessary rescue or a lost cause? Pain Physician. 2017;20(3):E345–56. https://www.ncbi.nlm.nih.gov/pubmed/28339434
14. Moraes VY, Lenza M, Tamaoki MJ, Faloppa F, Belloti JC. Platelet-rich therapies for musculoskeletal soft tissue injuries. Cochrane Database Syst Rev. 2014(4):CD010071. https://doi.org/10.1002/14651858.CD010071.pub3
15. Guven SC, Ozcakar L, Kaymak B, Kara M, Akinci A. Short-term effectiveness of platelet-rich plasma in carpal tunnel syndrome: A controlled study. J Tissue Eng Regen Med. 2019;13(5):709–14. https://doi.org/10.1002/term.281
16. Kesikburun S, Tan AK, Yilmaz B, Yasar E, Yazicioglu K. 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. 2013;41(11):2609–16. https://doi.org/10.1177/0363546513496542.
17. Kim SJ, Yeo SM, Noh SJ, et al. Effect of platelet-rich plasma on the degenerative rotator cuff tendinopathy according to the compositions. J Orthop Surg Res. 2019;14(1):408. https://doi.org/10.1186/s13018-019-1406-4
18. Lim W, Park SH, Kim B, Kang SW, Lee JW, Moon YL. Relationship of cytokine levels and clinical effect on platelet-rich plasma-treated lateral epicondylitis. J Orthop Res. 2018;36(3):913–20. https://doi.org/10.1002/jor.23714.
19. Nejati P, Ghahremaninia A, Naderi F, Gharibzadeh S, Mazaherinezhad A. Treatment of subacromial impingement syndrome: Platelet-rich plasma or exercise therapy? A randomized controlled trial. Orthop J Sports Med. 2017;5(5):2325967117702366. https://doi.org/10.1177/2325967117702366
20. Pasin T, Ataoglu S, Pasin O, Ankarali H. Comparison of the effectiveness of platelet-rich plasma, corticosteroid, and physical therapy in subacromial impingement syndrome. Arch Rheumatol. 2019;34(3):308–16. https://doi.org/10.5606/ArchRheumatol.2019.7225.
21. Raeissadat SA, Karimzadeh A, Hashemi M, Bagherzadeh L. Safety and efficacy of platelet-rich plasma in treatment of carpal tunnel syndrome; a randomized controlled trial. BMC Musculoskelet Disord. 2018;19(1):49. https://doi.org/10.1186/s12891-018-1963-4
22. Tetschke E, Rudolf M, Lohmann CH, Starke C. Autologous proliferative therapies in recalcitrant lateral epicondylitis. Am J Phys Med Rehabil. 2015;94(9):696–706. https://doi.org/10.1097/PHM.0000000000000234
23. Thu AC, Kwak SG, Shein WN, Htun M, Htwe TTH, Chang MC. Comparison of ultrasound-guided platelet-rich plasma injection and conventional physical therapy for management of adhesive capsulitis: A randomized trial. J Int Med Res. 2020;48(12):300060520976032. https://doi.org/10.1177/0300060520976032
24. Unlu B, Calis FA, Karapolat H, Uzdu A, Tanigor G, Kirazli Y. Efficacy of platelet-rich plasma injections in patients with adhesive capsulitis of the shoulder. Int Orthop. 2021;45(1):181–90. https://doi.org/10.1007/s00264-020-04518-9
25. Wesner M, Defreitas T, Bredy H, et al. A pilot study evaluating the effectiveness of platelet-rich plasma therapy for treating degenerative tendinopathies: A randomized control trial with synchronous observational cohort. PLoS One. 2016;11(2):e0147842. https://doi.org/10.1371/journal.pone.0147842
26. Wu YT, Ho TY, Chou YC, et al. Six-month efficacy of platelet-rich plasma for carpal tunnel syndrome: A prospective randomized, single-blind controlled trial. Sci Rep. 2017;7(1):94. https://doi.org/10.1038/s41598-017-00224-6
27. Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. J Clin Epidemiol. 2009;62(10):e1–34. https://doi.org/10.1016/j.jclinepi.2009.06.006
28. Bird SB, Dickson EW. Clinically significant changes in pain along the visual analog scale. Ann Emerg Med. 2001;38(6):639–43. https://doi.org/10.1067/mem.2001.118012
29. Mintken PE, Glynn P, Cleland JA. Psychometric properties of the shortened disabilities of the Arm, Shoulder, and Hand Questionnaire (QuickDASH) and Numeric Pain Rating Scale in patients with shoulder pain. J Shoulder Elbow Surg. 2009;18(6):920–6. https://doi.org/10.1016/j.jse.2008.12.015
30. Franchignoni F, Vercelli S, Giordano A, Sartorio F, Bravini E, Ferriero G. Minimal clinically important difference of the disabilities of the arm, shoulder and hand outcome measure (DASH) and its shortened version (QuickDASH). J Orthop Sports Phys Ther. 2014;44(1):30–9. https://doi.org/10.2519/jospt.2014.4893
31. Gummesson C, Ward MM, Atroshi I. The shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH): Validity and reliability based on responses within the full-length DASH. BMC Musculoskelet Disord. 2006;7:44. https://doi.org/10.1186/1471-2474-7-44
32. Breckenridge JD, McAuley JH. Shoulder Pain and Disability Index (SPADI). J Physiother. 2011;57(3):197. https://doi.org/10.1016/S1836-9553(11)70045-5
33. Roy JS, MacDermid JC, Woodhouse LJ. Measuring shoulder function: A systematic review of four questionnaires. Arthritis Rheum. 2009;61(5):623–32. https://doi.org/10.1002/art.24396
34. Hamzeh HH, Alworikat NA. Cross cultural adaptation, reliability and construct validity of the Boston Carpal Tunnel Questionnaire in standard Arabic language. Disabil Rehabil. 2021;43(3):430–5. https://doi.org/10.1080/09638288.2019.1629651
35. Leite JC, Jerosch-Herold C, Song F. A systematic review of the psychometric properties of the Boston Carpal Tunnel Questionnaire. BMC Musculoskelet Disord. 2006;7:78. https://doi.org/10.1186/1471-2474-7-78
36. Lue YJ, Lu YM, Lin GT, Liu YF. Validation of the Chinese version of the Boston Carpal Tunnel Questionnaire. J Occup Rehabil. 2014;24(1):139–45. https://doi.org/10.1007/s10926-013-9438-9
37. Celik D. Psychometric properties of the Mayo Elbow Performance Score. Rheumatol Int. 2015;35(6):1015–20. https://doi.org/10.1007/s00296-014-3201-1
38. Sun Z, Li J, Luo G, Wang F, Hu Y, Fan C. What constitutes a clinically important change in Mayo Elbow Performance Index and range of movement after open elbow arthrolysis? Bone Joint J. 2021;103-B(2):366–72. https://doi.org/10.1302/0301-620X.103B2.BJJ-2020-0259.R3
39. Michener LA, McClure PW, Sennett BJ. American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, patient self-report section: Reliability, validity, and responsiveness. J Shoulder Elbow Surg. 2002;11(6):587–94. https://doi.org/10.1067/mse.2002.127096
40. Malavolta EA, Yamamoto GJ, Bussius DT, et al. Establishing minimal clinically important difference for the UCLA and ASES scores after rotator cuff repair. Orthop Traumatol Surg Res. 2022;108(2):102894. https://doi.org/10.1016/j.otsr.2021.102894
41. Vascellari A, Venturin D, Ramponi C, et al. Psychometric properties of three different scales for subjective evaluation of shoulder pain and dysfunction in Italian patients after shoulder surgery for anterior instability. J Shoulder Elbow Surg. 2018;27(8):1497–504. https://doi.org/10.1016/j.jse.2018.02.059
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Published
Jul 7, 2022
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How to Cite
Kirker, K., & Masaracchio, M. (2022). Platelet-Rich Plasma and Rehabilitation for Upper Extremity Musculoskeletal Pathologies: A Systematic Review with Meta-Analysis. Biologic Orthopedics Journal, 4(SP1), e4-e29. https://doi.org/10.22374/boj.v4iSP1.43
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Review Articles
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Author Biographies
Kaitlin Kirker, Long Island University, Brooklyn, NY
Department of Physical Therapy, Long Island University, Brooklyn, NY
Michael Masaracchio, Long Island University, Brooklyn, NY
Department of Physical Therapy, Long Island University, Brooklyn, NY