Comparative efficacy of platelet rich plasma, hyaluronic acid, and corticosteroid injections in adhesive capsulitis management: A meta-analysis.

Abstract

Objective: To compare the efficacy of platelet-rich plasma (PRP) and hyaluronic acid (HA) against corticosteroid injections in adult patients with adhesive capsulitis (AC), in impacting pain relief and range of motion (ROM).

Literature survey: A systematic review was conducted between January and February 2024 through PubMed and Google Scholar using the following keywords: "PRP," "Hyaluronic Acid," "Bone Marrow Aspirate," "Frozen Shoulder," "Periarthritis," "Adhesive Capsulitis," and "Corticosteroid Injections." Inclusion criteria were studies published between January 2019 and February 2024 and used corticosteroids as a comparison for orthobiologic treatment. The initial search yielded 47 studies, refined to 21 after applying eligibility criteria. Ultimately, six studies were selected.

Methodology: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed, a Cochrane Risk of Bias analysis was performed, and data were independently extracted by multiple authors. A meta-analysis was conducted to compare the efficacy of PRP and HA against corticosteroids measured by visual analog scale (VAS), Shoulder Pain and Disability Index (SPADI), Disabilities of the Arm, Shoulder, and Hand (DASH), and UCLA Shoulder scores.

Synthesis: Qualitatively, studies with 3 months or longer patient follow-ups demonstrated better long-term efficacy in pain reduction and ROM improvement with PRP or HA injections. A 6-month improvement in pain as measured by VAS had a significant standardized mean difference (SMD) of -1.31 (95% confidence interval [CI], -1.56 to 1.04). There were significant improvements in functional outcomes at 6 months in DASH (SMD of -1.23 [95% CI, -1.71 to -0.74]) and UCLA Shoulder scores (SMD of 0.74 [95% CI, 0.47-1.00]): No significant differences were observed in 3-month outcomes: DASH (SMD of -0.12 [95% CI, -0.54 to 0.30]) and SPADI scores (SMD of -0.34 [95% CI, -0.78 to 0.10]). Cochrane analysis identified one study with high risk of bias.

Conclusions: The review highlights orthobiologics as a promising alternative to corticosteroid injections in managing AC, with PRP providing more long-term pain relief compared to corticosteroid injections. Improvements in shoulder ROM were also seen but require further studies to determine their significance. However, substantial heterogeneity (I² > 50) was observed, underscoring the need for future research to standardize methodologies and improve consistency.