Reference | Study type | Interventions | Inclusion criteria | Number of patients | Age | Gender (male/female) | Dropout Rate | Injection | Outcome measure | Follow-up | Adverse effects | Main results |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Byun et al. [17], Korea | RCT | Corticosteroid vs. corticosteroid + SH | Partial or full-thickness tear of rotator cuff or subacromial bursitis | 13/13 | 55.5/55.4 | 6/20 | NR | 1 mL of triamcinolone acetonide (40 mg) and 5 mL of 0.5% lidocaine with or without SH; Subacromial injection | ROM, VAS, SFA, SDQ | 3w | NR | The combination injection of corticosteroid had additive effects on the improvement of AROM and SFA scores |
Cai et al. [18], China | RCT | SH vs. PRP vs. SH + PRP vs. placebo | Partial rotator cuff tears | 44/45/48/47 | 39/41/40/40 | 99/85 | 7/184 | SH: 4 mL PRP: 4 mL SH + PRP: 2 mL of SH and 2 mL of PRP Placebo: 4 mL of normal saline; Subacromial injection | ASES, VAS, constant score | 1 m, 3 m, 6 m, 12 m | NR | The SH + PRP group showed a significantly improvement in all outcomes at 12 months compared with SH or PRP alone |
Chou et al. [19] Taiwan | RCT | SH vs. placebo | Rotator cuff tears without complete tears | 25/26 | 51.1/52.4 | 19/32 | NR | 25 mg of SH or 2.5 mL of normal saline; Subacromial injection | Constant score, VAS, global improvement | 6w | NR | The SH group had a better Constant score(p < 0.0095) and VAS score (p < 0.0018) than the placebo group 6 weeks after treatment |
Dadgostar et al. [20], Iran | RCT | PRP vs. corticosteroid | Incomplete rotator cuff tear or tendinitis | 30/28 | 57.3/53.6 | 11/47 | NR | 3Â mL of PRP or 1Â mL of Depo-medrol (40Â mg) and 1Â mL of lidocaine (2%); Subacromial injection | ROM, VAS, WORC, DASH | 1w, 1Â m, 3Â m | NR | The PRP group had significant improvements in ROM and VAS during 3Â months follow-up |
Gialanella et al. [21], Italy | RCT | Corticosteroid (single injection) vs. corticosteroid (two injections) vs. placebo | Full-thickness rotator cuff tear | 20/20/20 | 78.7/77.3/79.4 | 5/55 | NR | G1: single intraarticular injection of 40 mg triamcinolone acetonide G2: two injections of 40 mg triamcinolone acetonide G3: no treatment; Intraarticular injection | VAS, Constant score | 1 m, 3 m, 6 m | NR | Corticosteroid improved VAS scores at 1 and 3 months (p < 0.05), but two injections of steroids did not enhance the effect |
Huang et al. [29], Taiwan | Prospective | PRP (single injection) vs. HA (three injections) | Partial rotator cuff tears | 24/24 | 61.8/61.8 | 11/37 | 6/54 | 4Â mL of PRP or 2Â mL of HA; Subacromial injection | SPADI, constant score, VAS, ROM | 1Â m, 3Â m | NR | Single PRP injection exhibited comparable benefit to three doses of HA injection short-termly |
Jo et al. [22], Korea | RCT | PRP vs. corticosteroid | Partial rotator cuff tears or tendinopathy | 30/30 | 55.3/52.5 | 20/40 | 11/60 | 4Â mL of allogeneic PRP or a 4Â mL mixture of 1Â mL of 40Â mg/mL triamcinolone acetonide and 3Â mL of 2% lidocaine; Subacromial injection | Constant score, VAS, ROM, SPADI, ASES, SST, DASH | 1w, 1Â m, 3Â m, 6Â m | NR | No significant difference were reported between two groups in constant score at 1Â month, but the PRP group had better DASH score, overall function and external rotation than steroid group |
Kesikburun et al. [23], Turkey | RCT | PRP vs. placebo | Rotator cuff tendinosis or partial tendon tear | 20/20 | 45.5/51.4 | 13/27 | NR | 5Â mL of PRP or 5Â mL of normal saline; Injection under the posterolateral aspect of the acromion; Subacromial injection | WORC, SPADI, VAS, ROM | 3w, 6w, 12w, 24w, 1y | NR | PRP injection was found to be no more effective in WORC, SPADI and VAS scores than placebo in patients treated with an exercise program |
Kwong et al. [24], Canada | RCT | PRP vs. corticosteroid | Rotator cuff tendinopathy or partial tears | 47/52 | 49.9/49.1 | 35/64 | NR | 5Â mL of PRP or a mixture of 1Â mL of 40Â mg/mL triamcinolone and 2Â mL of 0.5% bupivacaine; Subacromial injection | VAS, ASES, WORC | 6w, 3Â m, 12Â m | NR | PRP group obtained more improvement in pain and function at 3Â months follow-up, but no sustained benefit at 12Â months follow-up |
Moghtaderi et al. [25], Iran | RCT | SH vs. placebo | Rotator cuff disease without complete tears | 20/20 | NR | 14/26 | NR | 2Â mL of SH (20Â mg) or 2Â mL of normal saline; Subacromial injection | Constant score, VAS | 1w, 2w, 3w, 12w | NR | The SH group had better improvements in VAS and constant score compared with placebo |
Sari et al. [26], Turkey | RCT | PRP vs. corticosteroid vs. prolotherapy vs. placebo | Rotator cuff tendinosis or partial tears | 33/33/32/31 | 52.1 | 43/77 | 9/129 | G1: 5Â mL of PRP G2: 2Â mL 40Â mg triamcinolone acetonide and 1Â mL 1% lidocaine and 1Â mL saline G3:a mixture of 4Â mL 20% dextrose and 1Â mL lidocaine G4: a mixture of 3Â mL 1% lidocaine 134 and 2Â mL saline solution; subacromial injection | VAS, ASES, WORC | 3w, 12w, 24w | NR | The steroid group had lower VAS and WORC scores than other groups in the 3rd week. In the PRP group in the 24th week, VAS and WORC scores were found to be significantly lower than the COR group |
Schwitzguebel et al. [27], Switzerland | RCT | PRP vs. placebo | Interstitial supraspinatus tears | 41/39 | 48.2/47.6 | 45/80 | 4/84 | 2Â mL of PRP or 2Â mL of normal saline; Subacromial injection | VAS, ASES, constant score, SANE | 7Â m, 12Â m | The PRP group had significantly higher incidence of adverse effects (pain 48Â h, frozen shoulder, extension of lesion to bursal or articular surface) compared with the control group (54% vs 26%) | PRP injections tears did not improve tendon healing or clinical scores compared with saline injections and were associated with more adverse events |
Setaro et al. [30], Italy | Prospective | Corticosteroid vs. HA (median molecular weight) vs. HA (high molecular weight) | Partial rotator cuff tears | 20/20/20 | 57 | 26/34 | NR | G1: 40 mg of methylprednisolone acetate G2: 40 mg of medium molecular weight HA (1000–1500 kDa) G3: 40 mg of high molecular weight HA (2500–3500 kDa); Intraarticular injections | VAS, OSS, constant score, ROM | 2w, 1 m, 2 m, 4 m | NR | Medium molecular weight HA showed greater efficacy in terms of pain reduction and functional recovery of the shoulder joint |
Shams et al. [28], Egypt | RCT | PRP vs. corticosteroid | Partial rotator cuff tears | 20/20 | 51 | 21/19 | NR | 5Â mL of PRP or 5Â mL of triamcinolone acetonide (40Â mg); Subacromial injection | Constant score, ASES, SST, VAS | 6w, 12w, 6Â m | NR | The PRP group showed better results as compared to corticosteroid injections at 12Â weeks, although statistically significant better results after 6Â months could not be found |
Tagliafico et al. [31], Italy | Prospective | HA vs. control | Massive rotator cuff tears | 30/60 | 72/71 | 36/54 | NR | Subacromial injection of HA (500 to 730 kD) | Constant score, VAS | 1 m, 2 m, 3 m, 4 m, 5 m, 6 m | NR | The HA group presented a significant improvement in VAS and constant scores at 1–4 months, but no difference after 5 months follow-up |
Wehren et al. [32], Switzerland | Prospective | PRP vs. corticosteroid | Partial rotator cuff tears | 25/25 | 53/55 | 26/24 | NR | 5Â mL of PRP or 5Â mL of triamcinolone acetonide (40Â mg); Subacromial injection | Constant score, ASES, SST, VAS | 6w, 12w, 6Â m | NR | PRP injections show earlier benefit as compared to corticosteroid injections at 6 and 12Â weeks, although a statistically significant difference after 6Â months could not be found |