Description
Topic: Shoulder - Non-operative Treatment
Objectives: The aim of this study was to determine whether there is benefit in the treatment of partial ruptures of the supraspinatus tendon of the shoulder with ultrasound-guided injections of platelet-rich plasma.
Methods: Monocentric observational retrospective study of 30 cases with partial shoulder supraspinatus tendon ruptures were treated with 1 or 2 ultrasound-guided intra-tendinous injections of the shoulder with Platelet Rich Plasma (PRP). Patients underwent VAS and ASES questionnaires at the beginning at 3 months and at 1 year after the procedure. Effect Size (EF) statistically significative results and the Minimum Clinically Important Difference (MCDI) were studied with data in VAS and ASES.
Informed consent was obtained from the patients that participated to collect their data. This study got a favourable permission certificate from the Ethics Committee of Hospital Universitario Virgen de la Arrixaca Murcia Spain to investigate in the medical field.
Results: Mean VAS scores improved from 6,7 [CI 6,0–7,3] pre-injection to 3,6 [CI 2,6–4,5] at 3 months and 4,4 [CI 3,2–5,6] at 1 year (p < 0.05 for all). In relation with the Effect Size (ES) we verify that the change is large in both, in preoperative comparison with 3 months and in the preoperative situation with the post-injection at 1 year with values of Cohen’s d>0’8. Regarding MCDI 23 patients (76’7%) presented a decrease of 2 or more points in VAS at 3 months. At one year, patients that decreased VAS were 18 (60%). The patients who presented this difference between the 3 month post-treatment and the year were 15 of which 6 (20%) decreased the VAS and 9 (30%) increased it. The mean ASES scores (0-100, 100 best) improved from 41.2 [CI 35.2– 47.3] for all patients before treatment to 62.7 [CI 56.7-68.9] at 3 months and 57.6 [CI 48.7– 66.5] at 1 years (p < 0.05 for all). In relation to the ES we found that the change produced is large at 3 months (Cohen's d 1.2) but is reduced to moderate from the pre-injection situation when we assess it at one year (Cohen's d 0.6). Regarding MCDI 24 patients (80%) presented an increase of ≥ 7 points in ASES at 3 months. At one year, patients with this increase in preoperative ASES were 19 (63.3 %). There were 22 patients who presented this difference between 3 months post-treatment and one year, of which 11 (36.7 %) increased their ASES and 11 (36.7 %) decreased it. When separated into subgroups based on supraspinatus partial tear types, there are no significant
differences for p < 0.05 between the 3 types of rupture in relation to pain at any time in which it has been assessed with pain VAS. Only 4 patients present omalgia post-injection as adverse events.
Conclusions: PRP injection is a safe and effective treatment for partial ruptures of supraspinatus muscle tendon in patients who have failed conservative treatment of activity modification and physical therapy without deterioration of results one years after treatment. Types of supraspinatus partial tear: bursal, intrasubstance or articular does not influence the pain or functionality, nor in the response with PRP.
