Hyaluronate Acid Plus Platelet-Rich Plasma Is Superior to Steroids for Pain Relief Less Than 6 Months Using Injection Therapy of Partial Rotator Cuff Tears: A Systematic Review and Network Meta-analysis

Viktor Weninger M.D. , Gergely Agócs Ph.D. , Norbert Kovács M.D. , Szilárd Váncsa M.D. , Luca Hergár M.D. , Chan Ju Baek , Péter Hegyi M.D., DSc. , Gergely Holnapy Ph.D. , Gábor Skaliczki M.D., Ph.D.
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引用次数: 0

Abstract

Purpose

To compare the efficacy of steroid injections to other injectable therapies in partial-thickness rotator cuff (RC) tears.

Methods

A systematic literature search was performed until October 25, 2021, in 3 databases (Cochrane Central Register of Controlled Trials, Embase, MEDLINE). Eligible studies compared the efficacy of steroid, hyaluronic acid (HA), platelet-rich plasma (PRP), the combination of HA and PRP (HA + PRP), and adipose-derived regenerative cells in RC tears. The primary outcomes were the visual analog scale (VAS), Constant-Murley Shoulder Outcome Score (CMS) and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form. Using paired and network meta-analysis, we calculated pooled mean differences (MDs) with 95% confidence intervals (CIs).

Results

We included a total of 7 articles in the quantitative synthesis. In shorter periods, the HA + PRP combination was superior to the other substances we investigated (HA + PRP: VAS [0-4 weeks]: MD: −0.99 [95% CI, −1.62 to −0.36]; CMS [0-3 months]: 20.56 [95% CI, 16.18 to 24.94]. This combination was followed by the use of HA or PRP alone, depending on the duration of follow-up and the outcome being studied. In our study, short-term results suggest that saline is superior to steroids for partial tears, but this trend is reversed at 6-month follow-up.

Conclusions

The HA and PRP combination is currently the most effective in partial RC tear treatment in the short term. After 6 months, there is no meaningful difference, so the benefits of the combination are short term.

Level of Evidence

Level II, systematic review and meta-analysis of Level I and II studies.
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使用注射疗法治疗部分肩袖撕裂后 6 个月以内的疼痛缓解效果,透明质酸加血小板丰富血浆优于类固醇:系统综述和网络荟萃分析。
目的:我们进行了网络荟萃分析,比较类固醇注射与其他注射疗法对部分厚度肩袖撕裂(PTRCTs)的疗效:在三个数据库(CENTRAL、Embase、MEDLINE)中进行了系统性文献检索,截止日期为 2021 年 10 月 25 日。符合条件的研究比较了类固醇、透明质酸(HA)、富血小板血浆(PRP)、HA 和 PRP 组合(HA+PRP)以及脂肪源性再生细胞(ADRC)对 RC 撕裂的疗效。主要研究结果为视觉模拟量表(VAS)、恒定默利评分(CMS)和美国肩肘外科医生标准化肩关节评估表。通过配对分析和网络荟萃分析,我们计算了汇总的平均差异(MDs)和 95% 的置信区间(CIs):结果:我们共纳入了七篇文章进行定量综合分析。在较短时间内,HA+PRP 组合优于我们研究的其他物质(HA+PRP:VAS(0-4 周):MD:-0.99 [CI = -1.62, -0.36];CMS(0-3 个月):20.56 [CI = 16.18, 24.94]。根据随访时间的长短和研究结果的不同,这种组合之后是单独使用 HA 或 PRP。在我们的研究中,短期结果表明生理盐水治疗部分撕裂优于类固醇,但这种趋势在随访六个月后发生逆转:结论:我们的研究结果表明,在短期内,HA 和 PRP 的组合对部分 RC 破裂是一种更有效的治疗选择,但在 6 个月后并无显著差异:II级,包括I-II级证据研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
9.30
自引率
17.00%
发文量
555
审稿时长
58 days
期刊介绍: Nowhere is minimally invasive surgery explained better than in Arthroscopy, the leading peer-reviewed journal in the field. Every issue enables you to put into perspective the usefulness of the various emerging arthroscopic techniques. The advantages and disadvantages of these methods -- along with their applications in various situations -- are discussed in relation to their efficiency, efficacy and cost benefit. As a special incentive, paid subscribers also receive access to the journal expanded website.
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