Abstract
Objective
To compare the effectiveness of diverse injections in patients with rotator cuff tendinopathy
using pairwise and network meta-analysis.
Data Sources
PubMed, EMBASE, Scopus, and Cochrane Library were searched for studies published up
to September 31, 2017.
Study Selection
We included all published or unpublished randomized controlled trials (RCTs) comparing
diverse injections including corticosteroid, nonsteroidal anti-inflammatory drugs,
hyaluronic acid, botulinum toxin, platelet-rich plasma (PRP), and prolotherapy in
patients with rotator cuff tendinopathy. Among the 1495 records screened, 18 studies
were included in the meta-analysis.
Data Extraction
The quality of RCTs was assessed with Cochrane Risk of Bias Tool by 2 independent
raters. The primary outcome was pain reduction, and the secondary outcome was functional
improvement.
Data Synthesis
Standardized mean difference (SMD) was used for pairwise and network meta-analysis.
In pairwise meta-analysis, corticosteroid was more effective only in the short term
in both pain reduction and functional improvement. Network meta-analysis indicated
that prolotherapy significantly reduced pain compared with placebo in the long term
(over 24wk; SMD: 2.63; 95% confidence interval [CI], 1.88-3.38); meanwhile PRP significantly
improved shoulder function compared with placebo in the long term (over 24wk; SMD:
0.44; 95% CI, 0.05-0.84).
Conclusions
For patients with rotator cuff tendinopathy, corticosteroid plays a role in the short
term (3-6wk) but not in long-term (over 24wk) pain reduction and functional improvement.
By contrast, PRP and prolotherapy may yield better outcomes in the long term (over
24wk). On account of heterogeneity, interpreting these results with caution is warranted.
Keywords
List of abbreviations:
BTX (botulinum toxin), CI (confidence interval), HA (hyaluronic acid), NSAID (nonsteroidal anti-inflammatory drug), PRP (platelet-rich plasma), RCT (randomized controlled trial), SMD (standardized mean difference)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: August 01, 2018
Footnotes
Disclosures: none.
Identification
Copyright
© 2018 by the American Congress of Rehabilitation Medicine
