Clinical effect of ultrasound-guided anterior platelet-rich plasma injection on the treatment of rotator cuff injury_West China Medical Journal

Authors：

HUANG Maomao , HU Yue , WAN Tenggang , WANG Jianxiong , ZENG Xin , ZHANG Chi ,  XU Fangyuan

Department of Rehabilitation Medicine, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P. R. China;

Corresponding author：

XU Fangyuan, Email: x5144@163.com

Keywords：

Musculoskeletal ultrasound; Platelet-rich plasma; Rotator cuff injury

DOI：

10.7507/1002-0179.201908119

Video：

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Objective To investigate the effect of ultrasound-guided anterior injection of platelet-rich plasma (PRP) combined with routine physiotherapy on pain and functional improvement in patients with rotator cuff injury.Methods The patients with rotator cuff injury treated in the Department of Rehabilitation Medicine, the Affiliated Hospital of Southwest Medical University from August 2017 to June 2018 were randomly divided into control group and PRP group. The control group was treated with routine physiotherapy for 4 weeks, and the PRP group was treated with PRP injection guided by musculoskeletal ultrasound (once a week, two injections) combined with routine physiotherapy for 4 weeks. The Shoulder Pain and Disability Index (SPADI) and the European Shoulder Association Constant-Murley Score (CMS) were used to evaluate the changes of pain and function before intervention, 12 weeks after intervention and 24 weeks after intervention.Results Finally, 65 patients were included, with 33 in the control group and 32 in the PRP group. Compared with the control group, there were significant differences in the CMS and SAPDI scores between the PRP group and the control group at 12 and 24 weeks after intervention (P<0.05), except before intervention (P>0.05). Twelve and 24 weeks after intervention, the CMS scores of the two groups were higher than those before intervention, while the SPADI scores were lower than those before intervention (P<0.05). The results of repeated measures analysis of variances showed that there was no statistical significance in group effect of CMS or SAPDI scores (F=2.753, P=0.102; F=2.724, P=0.104), but the time effects of CMS and SAPDI scores were statistically significant (F=251.002, P<0.001; F= 1 846.753, P<0.001), and there was interaction between group and time (F=4.931, P=0.020; F=36.405, P<0.001).Conclusion Anterior injection of PRP guided by musculoskeletal ultrasound combined with conventional physiotherapy is more effective than conventional physiotherapy in relieving shoulder pain and improving shoulder joint function.

Citation： HUANG Maomao, HU Yue, WAN Tenggang, WANG Jianxiong, ZENG Xin, ZHANG Chi, XU Fangyuan. Clinical effect of ultrasound-guided anterior platelet-rich plasma injection on the treatment of rotator cuff injury. West China Medical Journal, 2019, 34(12): 1407-1411. doi: 10.7507/1002-0179.201908119 Copy

1.	Yeo DY, Walton JR, Lam P, et al. The relationship between intraoperative tear dimensions and postoperative pain in 1 624 consecutive arthroscopic rotator cuff repairs. Am J Sports Med, 2017, 45(4): 788-793.
2.	Craig R, Holt T, Rees JL. Acute rotator cuff tears. BMJ, 2017, 359: j5366.
3.	陈红云, 黄秀军, 孔舒娅, 等. 肩关节抱枕在肩袖损伤修复中的应用. 实用医学杂志, 2017, 33(24): 4183-4185.
4.	Tohidnezhad M, Varoga D, Wruck CJ, et al. Platelet-released growth factors can accelerate tenocyte proliferation and activate the anti-oxidant response element. Histochem Cell Biol, 2011, 135(5): 453-460.
5.	Sampson S, Gerhardt M, Mandelbaum B. Platelet rich plasma injection grafts for musculoskeletal injuries: a review. Curr Rev Musculoskelet Med, 2008, 1(3-4): 165-174.
6.	De Pascale MR, Sommese L, Casamassimi A, et al. Platelet derivatives in regenerative medicine: an update. Transfus Med Rev, 2015, 29(1): 52-61.
7.	Brass L. Understanding and evaluating platelet function. Hematology Am Soc Hematol Educ Program, 2010, 2010: 387-396.
8.	Shams A, El-Sayed M, Gamal O, et al. Subacromial injection of autologous platelet-rich plasma versus corticosteroid for the treatment of symptomatic partial rotator cuff tears. Eur J Orthop Surg Traumatol, 2016, 26(8): 837-842.
9.	Jones A, Regan M, Ledingham J, et al. Importance of placement of intra-articular steroid injections. BMJ, 1993, 307(6915): 1329-1330.
10.	Micu MC, Iagnocco A. Musculoskeletal ultrasound guiding shoulder injection when " one picture is worth ten thousand landmarks”. Med Ultrason, 2013, 15(1): 3-5.
11.	李铁山. 肌骨超声与肩痛康复诊疗的动态可视化. 中国康复医学杂志, 2017, 32(10): 1098-1100.
12.	陆鹏, 杨小立, 尚翠侠, 等. 康复训练联合物理因子治疗肩袖损伤的临床疗效观察. 医学信息, 2018, 31(4): 184-185.
13.	曹贤畅. 肌内效贴布配合康复训练治疗肩周炎的临床观察. 中国康复, 2017, 32(6): 462-464.
14.	Heald SL, Riddle DL, Lamb RL. The shoulder pain and disability index: the construct validity and responsiveness of a region-specific disability measure. Phys Ther, 1997, 77(10): 1079-1089.
15.	Gilbart MK, Gerber C. Comparison of the subjective shoulder value and the constant score. J Shoulder Elbow Surg, 2007, 16(6): 717-721.
16.	Wang SZ, Rui YF, Tan Q, et al. Enhancing intervertebral disc repair and regeneration through biology: platelet-rich plasma as an alternative strategy. Arthritis Res Ther, 2013, 15(5): 220.
17.	Chen L, Dong SW, Liu JP, et al. Synergy of tendon stem cells and platelet-rich plasma in tendon healing. J Orthop Res, 2012, 30(6): 991-997.
18.	Zhang J, Middleton KK, Fu FH, et al. HGF mediates the anti-inflammatory effects of PRP on injured tendons. PLoS One, 2013, 8(6): e67303.
19.	Fredberg U, Stengaard-Pedersen K. Chronic tendinopathy tissue pathology, pain mechanisms, and etiology with a special focus on inflammation. Scand J Med Sci Sports, 2008, 18(1): 3-15.
20.	曾波. 超声引导下药物精准注射对肩袖损伤修复的临床研究. 太原: 山西医科大学, 2016.
21.	Rutgers M, Saris DB, Dhert WJ, et al. 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, 2010, 12(3): R114.
22.	Cervellin M, de Girolamo L, Bait C, et al. 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, 2012, 20(1): 114-120.
23.	Bosch G, Moleman M, Barneveld A, et al. The effect of platelet-rich plasma on the neovascularization of surgically created equine superficial digital flexor tendon lesions. Scand J Med Sci Sports, 2011, 21(4): 554-561.
24.	Heisterbach PE, Todorov A, Flückiger R, et al. Effect of BMP-12, TGF-beta1 and autologous conditioned serum on growth factor expression in achilles tendon healing. Knee Surg Sports Traumatol Arthrosc, 2012, 20(10): 1907-1914.
25.	Sethi PM, Kingston S, Elattrache N. Accuracy of anterior intra-articular injection of the glenohumeral joint. Arthroscopy, 2005, 21(1): 77-80.
26.	Henkus HE, Cobben LP, Coerkamp EG, et al. The accuracy of subacromial injections: a prospective randomized magnetic resonance imaging study. Arthroscopy, 2006, 22(3): 277-282.
27.	Rha DW, Park GY, Kim YK, et al. 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, 2013, 27(2): 113-122.
28.	Blanton MW, Hadad I, Johnstone BH, et al. Adipose stromal cells and platelet-rich plasma therapies synergistically increase revascularization during wound healing. Plast Reconstr Surg, 2009, 123(Suppl 2): 56S-64S.
29.	Sengodan VC, Kurian S, Ramasamy R. Treatment of partial rotator cuff tear with ultrasound-guided platelet-rich plasma. J Clin Imaging Sci, 2017, 7: 32.

1. Yeo DY, Walton JR, Lam P, et al. The relationship between intraoperative tear dimensions and postoperative pain in 1 624 consecutive arthroscopic rotator cuff repairs. Am J Sports Med, 2017, 45(4): 788-793.
2. Craig R, Holt T, Rees JL. Acute rotator cuff tears. BMJ, 2017, 359: j5366.
3. 陈红云, 黄秀军, 孔舒娅, 等. 肩关节抱枕在肩袖损伤修复中的应用. 实用医学杂志, 2017, 33(24): 4183-4185.
4. Tohidnezhad M, Varoga D, Wruck CJ, et al. Platelet-released growth factors can accelerate tenocyte proliferation and activate the anti-oxidant response element. Histochem Cell Biol, 2011, 135(5): 453-460.
5. Sampson S, Gerhardt M, Mandelbaum B. Platelet rich plasma injection grafts for musculoskeletal injuries: a review. Curr Rev Musculoskelet Med, 2008, 1(3-4): 165-174.
6. De Pascale MR, Sommese L, Casamassimi A, et al. Platelet derivatives in regenerative medicine: an update. Transfus Med Rev, 2015, 29(1): 52-61.
7. Brass L. Understanding and evaluating platelet function. Hematology Am Soc Hematol Educ Program, 2010, 2010: 387-396.
8. Shams A, El-Sayed M, Gamal O, et al. Subacromial injection of autologous platelet-rich plasma versus corticosteroid for the treatment of symptomatic partial rotator cuff tears. Eur J Orthop Surg Traumatol, 2016, 26(8): 837-842.
9. Jones A, Regan M, Ledingham J, et al. Importance of placement of intra-articular steroid injections. BMJ, 1993, 307(6915): 1329-1330.
10. Micu MC, Iagnocco A. Musculoskeletal ultrasound guiding shoulder injection when " one picture is worth ten thousand landmarks”. Med Ultrason, 2013, 15(1): 3-5.
11. 李铁山. 肌骨超声与肩痛康复诊疗的动态可视化. 中国康复医学杂志, 2017, 32(10): 1098-1100.
12. 陆鹏, 杨小立, 尚翠侠, 等. 康复训练联合物理因子治疗肩袖损伤的临床疗效观察. 医学信息, 2018, 31(4): 184-185.
13. 曹贤畅. 肌内效贴布配合康复训练治疗肩周炎的临床观察. 中国康复, 2017, 32(6): 462-464.
14. Heald SL, Riddle DL, Lamb RL. The shoulder pain and disability index: the construct validity and responsiveness of a region-specific disability measure. Phys Ther, 1997, 77(10): 1079-1089.
15. Gilbart MK, Gerber C. Comparison of the subjective shoulder value and the constant score. J Shoulder Elbow Surg, 2007, 16(6): 717-721.
16. Wang SZ, Rui YF, Tan Q, et al. Enhancing intervertebral disc repair and regeneration through biology: platelet-rich plasma as an alternative strategy. Arthritis Res Ther, 2013, 15(5): 220.
17. Chen L, Dong SW, Liu JP, et al. Synergy of tendon stem cells and platelet-rich plasma in tendon healing. J Orthop Res, 2012, 30(6): 991-997.
18. Zhang J, Middleton KK, Fu FH, et al. HGF mediates the anti-inflammatory effects of PRP on injured tendons. PLoS One, 2013, 8(6): e67303.
19. Fredberg U, Stengaard-Pedersen K. Chronic tendinopathy tissue pathology, pain mechanisms, and etiology with a special focus on inflammation. Scand J Med Sci Sports, 2008, 18(1): 3-15.
20. 曾波. 超声引导下药物精准注射对肩袖损伤修复的临床研究. 太原: 山西医科大学, 2016.
21. Rutgers M, Saris DB, Dhert WJ, et al. 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, 2010, 12(3): R114.
22. Cervellin M, de Girolamo L, Bait C, et al. 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, 2012, 20(1): 114-120.
23. Bosch G, Moleman M, Barneveld A, et al. The effect of platelet-rich plasma on the neovascularization of surgically created equine superficial digital flexor tendon lesions. Scand J Med Sci Sports, 2011, 21(4): 554-561.
24. Heisterbach PE, Todorov A, Flückiger R, et al. Effect of BMP-12, TGF-beta1 and autologous conditioned serum on growth factor expression in achilles tendon healing. Knee Surg Sports Traumatol Arthrosc, 2012, 20(10): 1907-1914.
25. Sethi PM, Kingston S, Elattrache N. Accuracy of anterior intra-articular injection of the glenohumeral joint. Arthroscopy, 2005, 21(1): 77-80.
26. Henkus HE, Cobben LP, Coerkamp EG, et al. The accuracy of subacromial injections: a prospective randomized magnetic resonance imaging study. Arthroscopy, 2006, 22(3): 277-282.
27. Rha DW, Park GY, Kim YK, et al. 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, 2013, 27(2): 113-122.
28. Blanton MW, Hadad I, Johnstone BH, et al. Adipose stromal cells and platelet-rich plasma therapies synergistically increase revascularization during wound healing. Plast Reconstr Surg, 2009, 123(Suppl 2): 56S-64S.
29. Sengodan VC, Kurian S, Ramasamy R. Treatment of partial rotator cuff tear with ultrasound-guided platelet-rich plasma. J Clin Imaging Sci, 2017, 7: 32.

West China Medical Journal

Clinical effect of ultrasound-guided anterior platelet-rich plasma injection on the treatment of rotator cuff injury

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