All right, so thank you for the invitation to speak at the Arthroscopy Association meeting today. Before you begin, I'd like to thank my co-authors listed here. So today, I'll be speaking to you about a prospective randomized controlled trial investigating the effect of platelet-rich plasma in partial thickness rotator cuff tears. So rotator cuff tears are one of the most common causes of adult shoulder pain. And while the treatment of full thickness tears is well studied, the optimal treatment of partial thickness tears remains elusive, normally including physiotherapy, PO analgesics, as well as corticosteroid injections. With the introduction of PRP, there is now potential for alternative treatments. PRP injections can be used for a variety of scenarios, including subacromial and glenohumeral injections, as well as post-operatively and rotator cuff repairs. However, the actual mechanism of action, be that anti-inflammatory, enhanced healing, or both, is not clear at this time, particularly in the clinical setting. Platelets in PRP contain over 30 bioactive proteins, many of which are involved in wound healing, cell adhesion, and cell migration. And while there have been a number of studies investigating PRP in these scenarios, results have generally been mixed, with small and underpowered studies leading to unclear conclusions. Therefore, the purpose of our study was to investigate the effect of PRP in a special subset of patients with partial thickness rotator cuff tears. Specifically, we investigated the effect of PRP on patient-reported outcomes, including the visual analog pain scale, the ASES score, and the WARC score. Secondarily, we wished to determine if there was any effect of PRP on both treatment failure, that is, requiring a second injection or progression to surgery, as well as if there was an effect on progression to full thickness tears. Our study design was a power, double-blinded, prospective RCT for PRP in partial thickness supraspinatus rotator cuff tears, or tendinopathy. Patients with image-confirmed pathology who failed three months of supervised non-operative management were randomized to either a corticosteroid or a PRP injection. All patients had baseline demographics and initial patient-reported outcome measures taken prior to their injection. And following injection, patients were reviewed at six weeks, 12 weeks, and 12 months after their injection, with repeat imaging also performed at the one-year time point. All investigators, aside from the radiology team, were blinded to the injection type, as all patients had blood drawn prior to their actual injection, and we utilized a leukocyte-poor PRP preparation for the injection protocol. The PRP injections were directed under ultrasound guidance at the partial thickness tear site, including both the bursal and articular surfaces of the tear, and then the remainder was injected into the subacromial space. To simulate the PRP injection and eliminate the effect of needling, patients that received corticosteroid injections had needle fenestrations of the supraspinatus tendon, but injection of the steroid was only performed into the subacromial space. All patients were then given the same post-injection protocol. So a total of 99 patients were randomized into this study and have full follow-up at the 12-week time point. We also have interim data on 68 patients at the 12-month time point. So in general, all patient demographics are equivalent between the two groups. However, despite random allocation, the pre-injection VAS and ASES scores were different between the two groups in that patients receiving PRP actually had more pain and worse scores on both ASES and WARC, with statistical significance at the VAS and ASES scores. So because of this discrepancy, we therefore decided to look at the change from baseline in the outcome scores rather than the mean of each score. So our data demonstrates a statistically significant difference in the change from preoperative to 12-week VAS pain score improvement versus baseline in PRP compared to patients who had treatment with corticosteroid at 12 weeks. Additionally, what you'll notice is that there's a significant difference between PRP patients and their baseline at one year, but no significant results at the one-year time point in the corticosteroid group. The remainder of the scores demonstrated a similar trend, but the groups did not achieve a statistical significance compared to one another. We therefore also looked at the change from baseline at both three months and one year and found a significant difference from baseline in the PRP groups at both three months and one year. The corticosteroid group only had a significant change from baseline at the one-year time point. It's also really easy to appreciate that the PRP group has a trend towards improved scores as well as maintained improvement versus their baseline when compared to the corticosteroid group. When we compare failure of treatment, we did not notice any difference between the two groups regarding surgical consent, progression of full thickness tear, or the requirement for a second injection between the two groups. So insofar, our data has therefore demonstrated improved pain scores with PRP over corticosteroid at 12 weeks post-injection and significant improvement from baseline in both groups at one year with a trend favoring PRP injections over corticosteroid for maintenance of pain control as well as improved quality of life. So I would like to once again thank my co-authors as well as the University of Calgary shoulder research group who provides help with patient recruitment, allocation, and statistical care as well as with ProCare and the University of Calgary orthopedic residency program. Thank you.

platelet-rich plasma

partial thickness rotator cuff tears

randomized controlled trial

patient-reported outcomes

corticosteroid injection