A Systematic Review of Platelet-Rich Plasma in the Management of Upper Limb Tendinopathies

Introduction: Currently, gold standards for treating upper-limb tendinopathies include steroid injections and operative treatment. However, these present a list of potential complications and hence, interest in alternative interventions, such as platelet-rich plasma (PRP), is growing. We review the recent high-level evidence discussing the use of PRP and its efficacy on three upper limb tendinopathies; lateral epicondylitis, rotator cuff tears, and impingement syndrome. Study Design and Methods: A literature search was performed using PubMed and the Cochrane Library. Level 1 and level 2 literature was included. Main outcomes included function, pain, and biological healing. Results: Fifteen studies were included (13 randomized control trials (RCTs) and 2 systematic reviews). Epicondylitis: Three RCTs reported increased benefit of PRP compared to corticosteroid (CS) injections and laser therapy. Other studies reported that PRP, CS, local anesthetic, and autologous whole blood are all beneficial. Benefits of PRP significantly increased in the long term. Rotator Cuff Tears: A mixture of results, potentially related to different methods of PRP administration. Impingement Syndrome: One study reports significant benefit when PRP used during decompression surgery. Conclusions: The variability of factors suggests that there is a need for standards of PRP to be set. However, even with such variability, PRP may be used as a safe and effective treatment for epicondylitis. The benefit of PRP use in rotator cuff repair augmentation is mixed and further evidence is needed to reach any conclusion for the use of PRP in subacromial decompression. Additional research is needed to determine optimum dosage and administration methods. Lay Summary: This article discusses new treatments for diseases involving the shoulder and elbow including tennis elbow, rotator cuff tendon tears, and impingement syndrome. This method of treatment is known as platelet-rich plasma (PRP). PRP is a substance which is gathered from the patients’ own blood and introduced to sites of tendon injuries via injection or as a gel. This substance includes factors that speed healing and recovery of these injured tendons. This in turn allows for reduction in pain and improvement in function of joints. Our review shows promising results for the use of PRP in treating these conditions. Future Works: Future works surrounding the use of platelet-rich plasma (PRP) will need to determine a gold standard for preparation of PRP. They will also attempt to establish the best practice for dosing and administering the substance. Future studies will aim to provide guidelines for bringing PRP into clinical practice. © 2017, The Regenerative Engineering Society.