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PRP for Rotator Cuff Tear Management

Updated: Jun 24

Rotator cuff tears are a common musculoskeletal injury that significantly impacts shoulder function and overall quality of life. As the field of clinical orthopedics continues to evolve, management strategies for these injuries have begun to incorporate biologically-based treatments designed to support tissue repair and recovery. Platelet-rich plasma (PRP) therapy, in particular, has gained prominence as a valuable addition to traditional treatment approaches, known for its potential to enhance the body's natural healing processes.


This article offers a thorough review of PRP therapy as it applies to managing rotator cuff tears, examining its underlying mechanisms, clinical applications, and supporting scientific evidence. We delve into the physiological foundation of PRP and discuss how it integrates into existing treatment protocols.


The goal is to provide healthcare providers with a deep understanding of PRP's effectiveness, the criteria for patient selection, and practical aspects of its use in clinical settings. Throughout the discussion, we present a balanced evaluation of the current research, pointing out both the benefits and limitations of PRP therapy in treating rotator cuff injuries.


What Are Rotator Cuff Tears?

Rotator cuff tears are injuries that affect one or more of the key muscles in the shoulder: the supraspinatus, infraspinatus, teres minor, and subscapularis, and can vary in severity from partial thickness tears to full-thickness injuries. These muscles are essential for stabilizing the shoulder joint and facilitating complex movements; injuries to these muscles can severely impair shoulder function, resulting in pain, weakness, and limited mobility, all of which can interfere with daily activities and reduce quality of life [1].


PRP for Rotator Cuff

To enhance outcomes for individuals experiencing rotator cuff tears, PRP therapy has been explored as a therapeutic option. PRP therapy utilizes a concentrated mixture of the patient’s own platelets and plasma, known to be rich in growth factors and cytokines that are thought to support the healing process. This treatment is administered through injections that directly deliver these bioactive components to the injured tissue, potentially creating an improved healing environment at the site of the injury.


Rotator Cuff Tear Variations & Terminology

Understanding the variety of rotator cuff tears is essential for accurate diagnosis and tailored treatment plans. Health care providers approached for platelet rich plasma injections should be made aware of any diagnosis already given to the patient in regards to their injury. From partial to full thickness tears, each type presents unique challenges and considerations for effective management.


Partial Rotator Cuff Tears

Partial rotator cuff tears involve damage to the tendon without complete disruption. These tears can vary in severity, affecting the function and stability of the shoulder joint. Early detection and appropriate interventions are crucial to prevent progression and optimize recovery.


Incomplete Rotator Cuff Tears

Incomplete rotator cuff tears signify a partial rupture of the tendon fibers, often resulting from repetitive stress or degenerative changes. While less severe than full-thickness tears, they can still cause significant pain and impairment. Timely diagnosis and targeted rehabilitation strategies are key to managing these tears effectively.


While both "incomplete" and "partial" can refer to a tear that does not extend fully through the tendon, they are not always used interchangeably, and their precise definitions can vary depending on the medical context.


"Incomplete" may describe a tear where the tendon fibers are not completely torn but may still have some disruption or damage. This term could encompass tears that are not fully through the thickness of the tendon or tears that are not fully across its width.


Full Thickness Rotator Cuff Tear

A full-thickness rotator cuff tear involves a complete disruption of the tendon, compromising the shoulder's integrity and function. These tears can be debilitating, affecting daily activities and quality of life. Treatment options can range from conservative measures to surgical repair, depending on the tear size, location, and patient factors.


Refractory Rotator Cuff Tendinopathy

Refractory rotator cuff tendinopathy refers to a persistent and resistant form of tendon inflammation and degeneration. Despite conservative treatments, such as rest, physical therapy, and medications, symptoms may persist or worsen over time. Advanced interventions, such as ultrasound-guided injections or surgical options, may be necessary to address refractory cases effectively.


Platelet Rich Plasma: Mechanism of Action

PRP therapy, characterized by the application of a concentrated suspension of platelets and growth factors, is increasingly being evaluated in the context of orthopedic injuries, including rotator cuff tears. This intervention, driven by the premise of supporting the body's intrinsic healing processes, involves the isolation of autologous platelets, which are then activated to release growth factors such as platelet-derived growth factor (PDGF), transforming growth factor beta (TGF-β), and vascular endothelial growth factor (VEGF). These factors are known to play pivotal roles in the healing cascade by modulating inflammatory responses and enhancing the proliferation and differentiation of cells critical for tissue repair [2].


PRP for Rotator cuff

PRP injections are prepared through a meticulous process that begins with the collection of a sample of the patient's own blood. This blood is then subjected to centrifugation, a method where the sample is spun at high speeds to separate the blood components based on their density. The resulting concentrated platelet-rich plasma is then ready to be applied to the injured area, where it is believed to release growth factors that aid in the natural healing process. [3]


The potential benefits of PRP for rotator cuff tear management are supported by its hypothesized action at the cellular level to facilitate the natural processes of healing. By concentrating these bioactive substances and applying them directly to the site of injury, PRP therapy aims to create an optimized local environment that could potentially support the quality of tissue repair, particularly in the context of tendon injuries, which traditionally suffer from poor healing capacity [4].


Current scientific discourse suggests that while the foundational premise of PRP therapy is promising, the clinical efficacy and optimal application of this treatment remain subjects of ongoing research. Clinical trials and meta-analyses have provided mixed outcomes, with some studies indicating a reduction in pain and improvement in function [5] [6], while others highlight a lack of significant difference compared to conventional management strategies [7].


As such, PRP for rotator cuff tears should be considered within a comprehensive treatment plan, including include physical therapy, for individual patient profiles and predicated on a thorough understanding of the scientific evidence. This approach ensures that healthcare providers can make informed decisions that best support therapeutic objectives and health outcomes for their patients.


Treatment Protocol For The Rotator Cuff

The administration of PRP for managing rotator cuff tears is a precise procedure that follows a strict protocol to maximize the treatment's effectiveness. It begins with an ultrasound-guided injection of PRP directly into the affected area of the rotator cuff. This advanced imaging technique ensures the PRP is delivered accurately to the intended site, potentially boosting the local biological activity and enhancing the overall success of the therapy.


PRP for Rotator Cuff

After the PRP injection, a structured recovery plan is implemented, starting with a period of rest followed by gradual movement. Patients are advised to avoid heavy or strenuous activities during the initial weeks post-injection to allow the natural healing processes facilitated by the PRP to take effect without interruption. As recovery progresses, patients typically engage in a physical therapy program designed to rebuild strength, flexibility, and functionality.


Clear communication with patients about what to expect from the treatment is essential. While many may see a decrease in pain and an improvement in mobility, outcomes can vary. The success of PRP therapy often depends on factors like the severity of the tear, the patient’s overall health, and their adherence to the rehabilitation program. It’s important for patients to understand that PRP therapy is intended to support healing but is not a guaranteed solution and should be considered a component of a broader treatment approach.


Ongoing follow-up care is crucial to monitor the patient's recovery and adjust the treatment plan as needed. Regular clinical evaluations, and sometimes imaging tests, are conducted to assess healing progress and decide on any necessary modifications. This meticulous care strategy ensures that treatment is tailored to each patient's unique health journey and clinical response.


Patient Selection

Selecting the right candidates for PRP therapy in treating rotator cuff tears involves a detailed evaluation of individual patient factors. The severity of the tear is crucial; PRP tends to be more beneficial for those with partial tears, where it can maximize support for the body’s natural healing processes.


Age also plays a significant role, as different age groups may respond differently to the treatment due to varying levels of physiological resilience. Furthermore, a patient’s activity level is important to consider, as those who are regularly engaged in activities that stress the shoulder might see different results than those who are less active.


PRP for Rotator Cuff

Creating a personalized treatment plan is key to effectively using PRP for rotator cuff tears. These plans should take into account not just the biological processes of healing but also the patient’s daily lifestyle, work demands, and personal health objectives. This customized approach ensures that PRP therapy is applied in contexts where it is most likely to be effective, guided by solid empirical evidence and clinical expertise.


Healthcare providers need to incorporate these factors into a thorough assessment process. This process will help guide their use of PRP injections as a treatment option, emphasizing a patient-centered approach in orthopedic care. The decision to use PRP therapy should be based on a comprehensive understanding of each patient’s specific condition and needs, ensuring that every therapeutic choice is as informed and beneficial as possible.


Adverse Effects and Complications

While PRP therapy is generally seen as a safe option, there are potential side effects that can occur, particularly with treatments for rotator cuff tears. Common issues include pain at the site of the injection, irritation of the surrounding tissue, and inflammation [8]. More rarely, patients may face complications such as infections or nerve damage. To reduce these risks, healthcare providers must adhere to meticulous techniques and strict aseptic procedures.


To further minimize the risk of complications, healthcare professionals employ precise ultrasound-guided injections to ensure the accurate delivery of PRP for rotator cuff tears. Screening patients before the procedure to rule out contraindications like clotting disorders or systemic infections is also crucial. After the injection, thorough follow-up care is essential to monitor the healing process and manage any potential complications.


Educating patients about what to expect after receiving PRP therapy, including possible side effects and signs of complications, is vital. Additionally, it's important to discuss the benefits and risks involved with PRP therapy in detail, ensuring patients provide informed consent. This discussion helps to ensure that patients are well-informed and actively engaged in their treatment plans, contributing to better outcomes and patient satisfaction.


Potential Limitations and Risks

As PRP therapy garners attention across various medical and aesthetic fields, it's imperative for healthcare professionals to critically assess its limitations and the risks entailed. A thorough comprehension of these factors is pivotal for guiding informed patient consultations on PRP therapy's broad applications.


1. Limited Clinical Evidence

The employment of PRP therapy, while promising, is marked by a scarcity of extensive, longitudinal clinical studies. The substantiation of PRP's effectiveness across different treatment areas, along with a nuanced understanding of its potential side effects and the identification of optimally responsive patient profiles, is an active field of study.

The variability observed in treatment efficacy, influenced by the health status and specific goals of individual patients, necessitates a prudent approach from practitioners. Staying abreast of emerging research and delivering a balanced evaluation of PRP therapy's potential and safety across its various applications is essential.


2. FDA Approval

The instruments and protocols for PRP preparation and application have received clearance from regulatory entities like the U.S. Food and Drug Administration. However, specific uses of PRP therapy lack explicit FDA endorsement. As PRP is derived from a patient's own biological materials, it falls outside the purview of drug regulation, affording healthcare providers discretion in its use, tailored to the unique requirements of their patients. [9]


3. Potential for Adverse Reactions

Despite PRP's autologous origin—which significantly reduces the chances of allergic reactions or rejection—there remains a possibility for adverse effects. These can encompass localized discomfort, injection site pain, infection risk, and other procedural complications. It is therefore crucial for healthcare providers to engage in detailed discussions with patients about these risks, ensuring a well-rounded understanding of the safety aspects of PRP therapy for diverse applications.


SELPHYL® Disclaimer

Instructions for the use of SELPHYL® can be found here and here.

SELPHYL® has not been approved by the FDA for subcutaneous, submucous, or intradermal injections in aesthetic medicine, and the safety and effectiveness of SELPHYL® for these conditions have not been established.


SELPHYL® is designed to be used for the safe and rapid preparation of autologous platelet-rich plasma (PRP) from a small sample of peripheral blood at the patient's point of care. The PRP is mixed with autograft and/or allograft bone prior to application to a boney defect to improve handling characteristics.

As of the time of writing, SELPHYL® has no known serious, life-threatening, or fatal risks apart from the adverse reactions described above.


SELPHYL® Limitations, Restrictions, Cautions, and Warnings

  • Prescription only.

  • Do not use the kit if the sterile packaging is damaged or compromised.

  • Follow universal safety precautions for blood collection and sharps disposal.

  • During blood draw, failure to align and properly seat tubes in the tube holder can result in a loss of vacuum and a loss of blood draw.

  • During PRP transfer, failure to align and securely seat tubes simultaneously in assembled blood transfer device tube holders can result in a loss of vacuum and the failure of PRP to transfer to the red-top PRFM tube.

  • Do not initiate the transfer of PRP into the red-top PRFM tube until the physician is ready to complete the procedure.

  • Do not reuse.


SELPHYL® Contraindications

These are not in FDA-required labeling and are part of SELPHYL®’s clinical evaluation for EU CE requirements.

  • Direct connection to a patient’s vascular system of circulating blood volume.

  • Other health conditions and diseases may also contraindicate the use of autologous PRP, including but not limited to low platelet count, sepsis, localized infection in the treatment area, anemia, malignancy with hematologic or bony involvement, and anticoagulation therapy.


Conclusion

PRP therapy has become an important addition to the treatment of rotator cuff tears, offering a potential boost to the body’s own healing processes. However, the effectiveness of PRP in this context still requires further investigation through rigorous clinical research to fine-tune its effectiveness, establish the best treatment protocols, and verify its long-term benefits. There's a clear need for more research to thoroughly understand how PRP works and to develop standardized approaches for its use.


Healthcare providers play a critical role in this evolving field and are urged to work together closely, sharing their insights and outcomes to help drive progress in treating rotator cuff tears.


This collaborative approach is essential for refining treatment methods and, ultimately, improving patient outcomes. As more research is conducted and new data becomes available, it will enable more informed decisions and help integrate PRP therapy more seamlessly into orthopedic practices, ensuring that patients receive the most effective care possible.


About the author: Dr. Ali is a medical journalist and copywriter.


References

  1. Bedi A, Bishop J, Keener J, Lansdown DA, Levy O, MacDonald P, Maffulli N, Oh JH, Sabesan VJ, Sanchez-Sotelo J, Williams RJ 3rd, Feeley BT. Rotator cuff tears. Nat Rev Dis Primers. 2024;10(1):8.

  2. Le, A. D. K., Enweze, L., DeBaun, M. R., & Dragoo, J. L. Platelet-rich plasma. Clinics in Sports Medicine. 2019. 38(1):17-44.

  3. Selphyl. About PRFM. Selphyl. Published June 1, 2023. https://www.selphyl.com/about-prfm 

  4. Rosso C, Morrey ME, Schär MO, Grezda K; Swiss Orthopaedics Shoulder Elbow and Expert Group; Swiss Orthopaedics Shoulder and Elbow Expert Group. The role of platelet-rich plasma in shoulder pathologies: a critical review of the literature. EFORT Open Rev. 2023;8(4):213-222.

  5. Hamid MS, Sazlina SG. Platelet-rich plasma for rotator cuff tendinopathy: A systematic review and meta-analysis. PLoS One. 2021;16(5).

  6. Kesikburun S, Tan AK, Yilmaz B, Yaşar E, Yazicioğlu 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):2609-2616.

  7. O'Dowd A. Update on the use of platelet-rich plasma injections in the management of musculoskeletal injuries: a systematic review of studies from 2014 to 2021. Orthop J Sports Med. 2022;10(12):23259671221140888.

  8. Jo CH, Lee SY, Yoon KS, Shin S. Effects of platelet-rich plasma with concomitant use of a corticosteroid on tenocytes from degenerative rotator cuff tears in interleukin 1β-induced tendinopathic conditions. Am J Sports Med. 2017;45(5):1141-1150.

  9. Johns Hopkins Medicine. Platelet-Rich Plasma (PRP) Injections. Accessed May 5, 2024. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/plateletrich-plasma-prp-treatment

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