Comparison of platelet-rich plasma injection versus corticosteroid injection for the treatment of frozen shoulder in Asia: A systematic review and meta-analysis of randomized controlled trials.

Abstract

This study investigates the therapeutic performance of intra-articular platelet-rich plasma (PRP) versus intra-articular corticosteroid injections, specifically evaluating outcomes within Asian demographic groups. This review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 statement. We assessed study quality with the Cochrane Risk of Bias 2 (RoB2) tool, Review Manager (RevMan) 5.4 for the meta-analysis, and GRADE analysis to assess the certainty of evidence. Our review includes 14 studies, with 11 analyzed through meta-analysis, involving 1295 patients. However, the included studies were limited to populations from India and Pakistan. In the short term, there were no significant differences between the PRP and corticosteroid groups in pain and disability scores. However, the PRP group showed significantly greater improvements in some aspects of range of motion (ROM). In the mid-term, the PRP group had significantly lower Visual Analog Scale (VAS) (mean difference [MD]: -9.67; 95% confidence interval [CI]: -19.36, -0.08), Disabilities of the Arm, Shoulder and Hand (DASH) (MD: -10.47, 95% CI: -20.82, -0.13), and Shoulder Pain and Disability Index (SPADI) scores (MD: -17.92, 95% CI: -28.14, -7.69) compared to corticosteroids, as well as greater ROM improvements across multiple measures (all P < 0.05). In the mid-long term, pooled analysis indicated that VAS (MD: -21.13, 95% CI: -33.35, -8.91), DASH (MD: -10.25, 95% CI: -16.87, -3.64), and SPADI scores (MD: -17.81, 95% CI: -30.89, -4.73) were significantly lower in the PRP group than in corticosteroids. Although PRP shows no immediate advantage over corticosteroids in pain and disability, it improves short-term ROM and provides superior mid- to mid-long-term outcomes. However, results should be interpreted cautiously due to high heterogeneity, varying RoB, and moderate to very low GRADE certainty.