BACKGROUND: Subacromial impingement syndrome (SAI) is a common cause of shoulder pain. Corticosteroid injection (CS) provides short-term relief, but concerns about tendon health and durability have increased interest in platelet-rich plasma (PRP) as an alternative. This meta-analysis compared pain and functional outcomes after PRP versus CS for SAI.
METHODS: A systematic review was performed per PRISMA guidelines. PubMed, Embase, and the Cochrane Library were searched for randomized controlled trials comparing PRP and CS for SAI. VAS pain scores and shoulder-specific functional outcomes were extracted, and random-effects meta-analyses were performed at baseline, short-term, and mid-term follow-up.
RESULTS: Eight studies (518 patients; 7 RCTs and 1 non-randomized comparative study) were included, with 259 patients per group. Baseline VAS scores were comparable (MD 0.03, 95% CI -0.09 to 0.15; I2 = 0%). Short- and mid-term VAS scores showed no significant difference between groups (short-term MD 0.47, 95% CI -0.35 to 1.29; mid-term MD 0.50, 95% CI -1.80 to 2.80), though heterogeneity was substantial (I2 = 93.6% and 98.0%), falling to 49.2% and 80.2% after excluding the non-randomized study. Functional outcomes were inconsistently reported; at 6 months, Constant score differences ranged from -13.0 to +17.2, and UCLA differences ranged from -0.6 to +0.3.
CONCLUSION: PRP and CS showed no significant difference in short- or mid-term pain relief for SAI, but heterogeneity between trials was substantial. Functional outcomes were inconsistently reported across studies. Current evidence does not show it is clinically superior to CS for pain relief, and treatment choice should still weigh cost, availability, and patient preference.
LEVEL OF EVIDENCE: Level II, Systematic Review.
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