In this video, we are going to talk about PRP, or platelet-rich plasma – what it is, why it might work, and why PRP might be especially useful for a rotator cuff tear.
Please understand, in this video, I am not giving you medical advice. This is meant for general information and educational purposes only.
What is platelet-rich plasma?
PRP, also known as platelet-rich plasma, is a concentration of platelets that comes from your whole blood. It is centrifuged to obtain a ready-to-use product.
PRP works by releasing cytokines and growth factors, like platelet derived growth factor, platelet derived endothelial growth factor, transforming growth factor β1, insulin-like growth factor 1, fibroblast growth factor 2, and vascular endothelial growth factor A.
These growth factors enhance healing by stimulating cell proliferation, migration, and differentiation. They also modulate the immune system, inflammation, and angiogenesis, or the development of new blood vessels in the damaged tissue.
Biologic mediators in PRP and how they help healing
Those growth factors are essential for the three phases of healing of injured tendons and ligaments: inflammation, proliferation, and remodeling. In theory, PRP allows for the patient’s own blood to provide a high concentration of growth factors to promote healing in sites that have limited healing capacity due to blood supply. PRP can create a matrix that serves as scaffold for sustained release of growth factors that help bring in healing cells and new blood vessels that help deliver nutrients to improve healing.
Now to understand why PRP may or may not be beneficial for a rotator cuff injury, we have to understand what that injury entails.
Rotator cuff tears and other injuries
These are strains, partial or complete tears of one or more of the four rotator cuff tendons. Rotator cuff injuries typically affect adults. In fact, youth, high school or college athletes rarely have rotator cuff pathology as a primary problem. People in their thirties and early forties rarely have a full-thickness tear without a significant traumatic event, such as a fall. Younger adults almost always have rotator cuff impingement without a full tear related to overuse. Adults in their fifties and beyond can develop full-thickness rotator cuff tears without a major injury. A partial-thickness tear usually responds to the rehabilitation and nonoperative treatment but occasionally needs surgery. A full-thickness tear is believed to rarely improve without surgery to repair the tendon.
Let’s see what recent scientific literature tells us about how effective PRP is for rotator cuff tears.
PRP and rotator cuff tears
A 2020 review of nine studies looking at PRP versus cortisone shots specifically for partial rotator cuff tears showed PRP was significantly better for pain and shoulder function in long-term follow up than cortisone, although only shoulder function was better for PRP in the first few months after the procedure.
In a 2019 study, when researchers looked at rotator cuff tendinopathy, a form of shoulder impingement, PRP had much better outcomes at six months or longer after the injection than cortisone injections.
Finally, a recent meta-analysis of 37 studies showed that patients with rotator cuff tears treated with PRP injections had significantly less pain compared with the control group.
Caution with the research
There are many different methods of preparation, and different final products: PRP, leukocyte-rich PRP, platelet-rich fibrin, platelet gel, and more. All these platelet products have varying concentrations of blood cells, plasma, or fibrinogen. Therefore, they have different concentrations of growth factors and bioactive molecules, meaning they could have different efficacy for rotator cuff tears.
The exact composition of PRP is not reported in many of the available studies. There are differences between leukocyte-rich and leukocyte-poor PRP and much more. Plus, humans have different numbers of platelets in our blood, so studies comparing PRP will lead different results.
Plus, other than the leukocyte content, research studies differ in terms of volume of blood harvested, use of anticoagulant, number and speed of centrifugations, the final volume of PRP obtained, the overall number of platelets, their integrity and activation method, and more. All of these factors that could influence the properties of the final PRP product and how well it helps patients with osteoarthritis.
Is PRP covered by insurance?
Most insurance companies still consider PRP experimental and will not cover these treatments. And again, I’m not giving you medical advice. This information about platelet-rich plasma is intended for informational and educational purposes only.
Based on these recent studies, platelet-rich plasma offers a benefit that, although not significant at the early follow-ups (1 to 2 months), appears to exceed the benefits over time, compared to cortisone shots. For someone looking to avoid or delay surgery for a rotator cuff injury, it might be worthwhile to discuss PRP as a treatment option with your doctor or orthopedic surgeon.
Links to studies in the comments
If you would like to read the studies I mentioned in the video, here are links to them:
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I’m Dr. David Geier. Thank you for watching, and I look forward to helping you feel and perform Better Than Ever.