Effects of platelet-rich plasma and prolotherapy on supraspinatus tendinopathy: a double blind randomized clinical trial.

BACKGROUND: Supraspinatus tendinopathy is a significant cause of pain and function loss. It has been suggested that platelet-rich plasma (PRP) and prolotherapy are effective treatments for this condition. This study was done to assess and compare the effects of PRP and prolotherapy on shoulder function and pain. The secondary aim was to evaluate the effect of the treatment on shoulder range of motion, supraspinatus tendon thickness, patient satisfaction, and adverse effects. METHODS: This was a randomized, double-blind clinical trial. The study included 64 patients over the age of 18 who had supraspinatus tendinopathy and had not responded to at least three months of conventional treatment. Patients were assigned to either receive 2 mL of PRP (N.=32) or prolotherapy (N.=32). The Shoulder Pain and Disability Index (SPADI) and the Numerical Rating Scale (NRS) were the primary outcomes. Secondary outcomes included shoulder range of motion (ROM), supraspinatus tendon thickness, and adverse effects, which were measured at baseline, 3, 6, and 6 months after injection. At six months, patient satisfaction was assessed. RESULTS: Repeated measures ANOVA showed there was a statistically significant effect of time on total SPADI scores (F [2.75, 151.11], = 2.85, P=0.040) and the NRS (F [2.69, 147.86], = 4.32, P=0.008) within each group. There were no other significant changes over time or between groups. Significantly more patients in the PRP group experienced increased pain lasting less than two weeks after injection (χ2=11.94, P=0.030). CONCLUSIONS: PRP and prolotherapy resulted in improved shoulder function and pain for patients with chronic supraspinatus tendinopathy who did not response to conventional treatment.

Efficacy of prolotherapy in comparison to other therapies for chronic soft tissue injuries: A systematic review and network meta-analysis.

INTRODUCTION: Prolotherapy and other injections, primarily acting on pathways associated with maladaptive tissue repair, are recommended for recalcitrant chronic soft tissue injuries (CSTI). However, selection of injection is challenging due to mixed results. This network meta-analysis (NMA) aimed to compare prolotherapy with other therapies, particularly injections, for CSTI and establish robustness of the results. METHODOLOGY: Pubmed, Medline, SPORTDiscus and Google scholar were searched from inception to 4th January 2021 for randomised controlled trials (RCTs) involving injection therapies (e.g. blood derivatives, corticosteroid, hyaluronic acid, botulinum toxin) for CSTI. The primary and secondary outcomes were pain and function, respectively, at (or nearest to) 6 months. Effect size (ES) was presented as standardised mean difference with 95% confidence interval (CI). Frequentist random effect NMA was used to generate the overall estimates, subgroup estimates (by region and measurement time point) and sensitivity analyses. RESULTS: A total of 91 articles (87 RCTs; 5859 participants) involving upper limb (74%), lower limb (23%) and truncal/hip (3%) injuries were included. At all time points, prolotherapy had no statistically significant pain benefits over other therapies. This observation remained unchanged when tested under various assumptions and with exclusion of studies with high risk of bias. Although prolotherapy did not offer statistically significant functional improvement compared to most therapies, its ES was consistently better than non-injections and corticosteroid injection for both outcomes. At selected time points and for selected injuries, prolotherapy demonstrated potentially better pain improvement over placebo (<4 months: shoulder [ES 0.65; 95% CI 0.00 to 1.30]; 4-8 months: elbow [ES 0.91; 95% CI 0.12 to 1.70]; >8 months: shoulder [ES 2.08; 95% CI 1.49, to 2.68]). Injections generally produced greater ES when combined with non-injection therapy. CONCLUSION: While clinical outcomes were generally comparable across types of injection therapy, prolotherapy may be used preferentially for selected conditions at selected times.