What is the evidence for platelet-rich plasma (PRP) versus corticosteroid injection in patients with rotator cuff disease for clinical function and pain reduction?
AMSTAR Rating
Summary
Patient Population:
Nine randomized controlled trials (RCTs) met eligibility criteria, encompassing a total sample size of n = 469 patients with rotator cuff disease, tendonitis, or partial thickness tears. The average age of patients across trials ranged from 41.50 to 57.33 years, and disease baseline severity was characterized by persistent shoulder pain lasting more than 2 to 3 months, confirmed via positive clinical physical examinations, ultrasound, or magnetic resonance imaging (MRI).
Intervention:
Platelet-rich plasma (PRP) injections. Patients across the included trials received a single subacromial injection of PRP. Dosing volumes ranged from 2 mL to 5 mL, prepared using either single centrifugation methods (e.g., 1500 rpm for 5 min or 3500 rpm for 10 min) or double centrifugation protocols (e.g., 1200 rpm to 1500 rpm for the first spin, followed by 1200 rpm to 3500 rpm for the second spin) from 10 mL to 30 mL of autologous or allogeneic blood.
Comparison:
Corticosteroid (COR) injections. Patients in the comparative arms received a single subacromial injection of a corticosteroid, including triamcinolone acetonide (40 mg), methylprednisolone acetate, or betamethasone dipropionate, which were frequently combined with local anesthetics such as lidocaine or prilocaine. Crucially, all patients in both treatment groups underwent standard structured physical therapy and sports rehabilitation programs following their injections.
Outcome:
Quantitative meta-analysis demonstrated that in the short term (2–6 weeks post-injection), corticosteroids were statistically superior to PRP for functional recovery as measured by the Constant-Murley Score (Mean Difference [MD] = -5.08; 95% CI, -10.26 to -0.06; p = 0.05), Simple Shoulder Test (SST) (MD = -0.97; 95% CI, -1.68 to -0.07; p = 0.03), and American Shoulder and Elbow Surgeons (ASES) scores (MD = -6.67; 95% CI, -12.85 to -0.49; p = 0.03).
At midterm follow-up (6–12 weeks), no statistically significant differences were observed between the two groups (p > 0.05).
In the long term (>12 weeks / up to 6 months), PRP demonstrated significantly greater improvements than corticosteroids for the ASES score (MD = 6.96; 95% CI, 3.90 to 9.61; p < 0.00001) and the SST score (MD = 1.21; 95% CI, 0.68 to 1.74; p < 0.00001).
*However, none of these differences at any follow-up window crossed the established minimal clinically important difference (MCID) thresholds (10 points for Constant, 17 points for ASES, and 1.5 points for SST), and no relevant treatment-related complications occurred in either arm.
Guideline Recommendations
| Source | Recommendation |
|---|---|
| AAOS, 2025 | Not supported (Partial tears) or may not be indicated (Full-thickness tears) |
| NICE, 2013 | Inadequate Evidence |
Outcomes Assessed
- Benefit
- Harm
- Inconclusive
Short-term (2-6 weeks) v. Cortisone
Pain
Function
Mid-term (6-12 weeks) v. Cortisone
Pain
Function
Long-term (12 weeks to 6 months) v. Cortisone*
Pain
Function
Relevant Clinical Info
Jo CH, Lee SY, Yoon KS, Oh S, Shin S. Allogeneic platelet-rich plasma versus corticosteroid injection for the treatment of rotator cuff disease: a randomized controlled trial. J Bone Joint Surg Am. 2020;102(24):2129-2137.
Jo et al. (2020) was a parallel-group RCT included in the meta-analysis, evaluating a total sample size of 60 patients with symptomatic rotator cuff disease and persistent shoulder pain lasting over 3 months. Participants were randomized to receive either a subacromial injection of platelet-rich plasma or an active corticosteroid comparison arm. The trial beautifully highlighted the clinical timeline divergence between the two therapies: while the corticosteroid group experienced superior pain reduction and functional scores at the very early 1-month check, the PRP group demonstrated superior durability and statistically significant functional gains in ASES and Constant scores at the final 6-month milestone without any reported complications.
Participant Information
The sample size was 469
There were 9 studies used.
