European Journal of Cardiovascular Medicine

Rotator cuff pathology is one of the most frequent causes of shoulder pain and disability, significantly affecting daily activities and work productivity in adults [1]. Among the components of the rotator cuff, the supraspinatus tendon is most commonly involved due to its critical role in shoulder abduction and its susceptibility to mechanical impingement and degenerative changes [2]. Partial-thickness tears of the supraspinatus tendon represent an intermediate stage in the disease spectrum and are increasingly detected with the widespread use of magnetic resonance imaging and high-resolution ultrasonography [3]. These tears may result in persistent pain, limitation of shoulder movements, reduced functional capacity, and progression to full-thickness tears if left inadequately treated [4].Non-operative management remains the initial treatment of choice for partial-thickness supraspinatus tears, particularly in patients without significant weakness or acute traumatic injury [5]. Conservative modalities include rest, physiotherapy, nonsteroidal anti-inflammatory drugs, and intervention namely image-guided injection therapies. Corticosteroid injections have traditionally been employed owing to their potent anti-inflammatory action and ability to provide rapid pain relief [6]. However, growing evidence suggests that corticosteroids may adversely affect tendon biology by inhibiting fibroblast proliferation, collagen synthesis, and tendon healing, potentially increasing the risk of tendon degeneration and tear progression, especially with repeated injections [7,8]. These limitations have led to increased interest in regenerative treatment options. Platelet-rich plasma (PRP) has emerged as a biological therapy aimed at enhancing tendon healing rather than merely alleviating inflammation [9]. PRP is an autologous concentration of platelets rich in growth factors such as platelet-derived growth factor, transforming growth factor-β, vascular endothelial growth factor, and insulin-like growth factor, which are known to play a crucial role in tissue repair, angiogenesis, and extracellular matrix remodelling [10]. The aim of this study was to compare the effectiveness of platelet-rich plasma and corticosteroid injections in patients with partial-thickness supraspinatus tendon tears by evaluating improvement in pain, shoulder function, and radiological healing outcomes.

Type of Study: A prospective, randomized controlled trial (RCT)

Place of Study: Department of Physical Medicine and Rehabilitation, Institute of Postgraduate Medical Education & Research (IPGME& R) and SSKM Hospital, 244, Acharya J.C. Bose Road, Kolkata, West Bengal, Pin Code-700020, India.

Study Duration: 1 year (From 1st February 2018 to 31st January 2019)

Sample Size: 100 patients presenting with symptomatic partial-thickness supraspinatus tendon tears.

Inclusion Criteria:

• Age 18–75 years.
• Clinical diagnosis of shoulder pain consistent with rotator cuff pathology.
• Imaging-confirmed partial-thickness tear of the supraspinatus on MRI or high-resolution ultrasound.
• Symptom duration ≥6 weeks despite a trial of conservative therapy
• Baseline pain intensity ≥4 on a 0–10 VAS or equivalent functional limitation on a recognized shoulder score qualifying for injection therapy.

Exclusion Criteria:

• Full-thickness rotator cuff tear on imaging or a partial tear >50% tendon thickness.
• Prior surgery on the affected shoulder.
• Corticosteroid injection into the affected shoulder within the preceding 3 months.
• Prior PRP injection into the affected shoulder.
• Concomitant shoulder pathology likely to affect outcomes.

Study Variables:

• Change in shoulder pain on Visual Analogue Scale at 6 months post-injection.
• Secondary outcomes
• Functional scores: Constant-Murley Score and/or Oxford Shoulder Score at baseline, 6 weeks, 3 months, 6 months and 12 months.
• Patient Global Impression of Change (PGIC) and satisfaction.
• Range of motion and isometric strength measurements.

Methods: In PRP Group, 2-3 ml of Autologous PRP injected into the tear area under USG guidance and in Corticosteroid group, 2 ml mixture (1 ml of 40mg Methylprednisolone Acetate plus 1 ml of 0.2% Ropivacaine) injection was given under USG guidance in aseptic condition.

Statistical Analysis:

Data were entered into Excel and subsequently analyzed using SPSS and GraphPad Prism. Continuous variables were summarized as means with standard deviations, while categorical variables were presented as counts and percentages. Comparisons between independent groups were performed using two-sample t-tests, and paired t-tests were applied for correlated (paired) data. Categorical data were compared using chi-square tests, with Fisher’s exact test applied when expected cell counts were small. A p-value of ≤ 0.05 was considered statistically significant.

Table 1: Baseline Demographics

Table 2: Pain (VAS 0–10), Functional Outcome (Constant-Murley Score)

Table 3: MRI Healing at 12 Weeks

Table 4: Patient Satisfaction

Table 5: Adverse Events Outcome

In our study, baseline characteristics were comparable between the PRP and corticosteroid groups, with mean ages of 45.2 ± 8.1 and 44.7 ± 7.9 years, respectively (p = 0.72), similar gender distribution (30 males and 20 females vs. 28 males and 22 females; p = 0.68), and comparable proportions of participants with the dominant side affected (70% vs. 66%; p = 0.65). The PRP group showed significantly greater improvement, with a mean VAS score improvement of 5.0 ± 1.0 versus 4.1 ± 1.2 in the corticosteroid group (p = 0.003) and a higher mean functional score improvement (25 ± 6 vs. 16 ± 5; p < 0.001). Healing rates were also higher in the PRP group, with 43 participants (86%) achieving complete or partial healing compared to 35 participants (70%) in the corticosteroid group (p = 0.05), and patient satisfaction was significantly greater (86% vs. 64%; p = 0.01). The incidence of adverse events was comparable between groups (22% vs. 28%; p = 0.52).

We found that, baseline characteristics were comparable between the PRP and corticosteroid groups, with mean ages of 45.2 ± 8.1 and 44.7 ± 7.9 years (p = 0.72), similar gender distribution (30 males and 20 females vs. 28 males and 22 females; p = 0.68), and comparable proportions of dominant side involvement (70% vs. 66%; p = 0.65). The PRP group showed significantly greater improvement, with a mean VAS score improvement of 5.0 ± 1.0 versus 4.1 ± 1.2 in the corticosteroid group (p = 0.003) and higher functional score gains (25 ± 6 vs. 16 ± 5; p < 0.001). Healing rates were also higher in the PRP group, with 43 participants (86%) achieving complete or partial healing compared to 35 participants (70%) in the corticosteroid group (p = 0.05), and patient satisfaction was significantly greater (86% vs. 64%; p = 0.01). Despite these benefits, adverse events were comparable between groups (22% vs. 28%; p = 0.52). In similar study by these findings are consistent with the randomized trial by Aslani et al. (2021), who reported that patients receiving PRP for partial-thickness supraspinatus tears had significantly greater pain relief and functional improvement at 6 months compared to corticosteroid, with no increase in adverse events [11]. Similarly, Kwong et al. (2020) observed superior short-term pain and functional outcomes in the PRP group, although differences diminished at 12 months [12]. A recent meta-analysis by Zhang et al. (2025) also concluded that PRP provides better mid-term pain and functional improvement than corticosteroid in tendinopathies, supporting the regenerative advantage of PRP observed in our study [13].

We concluded that based on our study, platelet-rich plasma (PRP) injections demonstrated superior efficacy compared to corticosteroids in managing partial-thickness supraspinatus tendon tears. Both groups were comparable at baseline in terms of age, gender distribution, and affected side. The PRP group showed significantly greater pain relief, with larger reductions in VAS scores, and better functional outcomes as evidenced by higher functional score gains. Radiological healing was also more favourable in the PRP group, with a higher proportion achieving complete or partial tendon repair. Patient satisfaction mirrored these improvements. Importantly, the incidence of adverse events was similar between the two groups, indicating that PRP is not only more effective but also safe. Overall, PRP offers a promising alternative to corticosteroids for enhancing pain relief, function, and tendon healing in partial-thickness supraspinatus tears.

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