Date of Award

2023

Document Type

Open Access Thesis

Degree Name

MS in Physician Assistant Studies (PA)

Department

Physician Assistant Studies

Abstract

Background: Tendinopathy is one of the most prevalent musculoskeletal disorders in active patients, accounting for at least 7% of physician visits in the United States. In recent years, there has been an increasing body of evidence for the use of platelet-rich plasma (PRP) in the management of tendinopathies compared to corticosteroid injections (CSI) for patients refractory to conservative treatment.

Methods: This review was performed in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The SPORTDiscus, PubMed, and Google Scholar databases were searched for randomized controlled studies published between 2010 and 2023. The keywords utilized in the search included a combination of the following: “platelet-rich plasma”, “corticosteroids”, “rotator cuff”, “gluteal tendinopathy”, “greater trochanteric”, and “lateral epicondylitis”. The Boolean connector “AND” was utilized to connect “platelet-rich plasma”, “corticosteroids”, and the various tendinopathy sites. Studies were excluded if PRP was combined with CSI or another alternate therapy, if it was performed in conjunction with surgical repair, or if the study population included a condition closely associated with the primary conditions screened for. The primary outcome measures analyzed across all injury types were pain, functional outcome scores, imaging findings, and clinical measures.

Results: Of the 385 studies initially screened, 21 were included in this review. 2 investigated the effects of PRP vs. CSI on the management of gluteal tendinopathy, 10 studies investigated the effects of PRP vs CSI on the management of rotator cuff tendinopathy, and 9 studies investigated the effects of PRP vs. CSI on the management of lateral epicondylitis. Across all three sites, most studies found CSI outperforming PRP in the short-term follow-up period up to 12 weeks. PRP patients tended to improve over time gradually and consistently while patients who received corticosteroids regressed back towards baseline regarding pain and function. There were no consistent significant differences found regarding imaging findings and clinical measures.

Discussion: This review has demonstrated the potential for successful treatment outcomes when utilizing PRP for chronic tendinopathies. The results generally show that while corticosteroids outperform PRP injections in the short term, PRP patients tend to slowly improve over time and surpass the results of the CSI group. Positive effects were demonstrated amongst all three tendinopathy sites, primarily with improvement in pain and function. With respect to imaging findings and clinical improvement, results varied between studies and no consistent conclusion can be drawn.

Identifier

SC 11.PAS.2023.Caloud.E

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