SHOULDER ARTHROSCOPY

Eric M. Parsons, M.D.

Q: You have written before about stem cells and other biologic treatments in shoulder surgery. Are there any updates?

A: Cell-based treatments continue to be a subject of great interest among investigators as we are always striving to improve healing following injuries and surgery. Unfortunately, up to this point the results of the research into such interventions (e.g., “stem cells,” PRP, etc.) have been at best mixed and in most cases have shown no benefit to patients. And when we consider the cost of these treatments and the potential for any medication or procedure to harm patients we should continue to exercise extreme caution here.

In the current issue of the American Journal of Sports Medicine, Schwitzguebel et al. conducted a randomized, double-blind trial examining the effect of platelet rich plasma (PRP) on rotator cuff healing. This is most rigorous and therefore accurate design of research as it selects patients at random to either receive PRP or not and also shields both the patient and the doctor from knowing whether the patient received the PRP or not. This minimizes the potential for bias because believe it or not just knowing that you or your patient received a particular treatment can affect the way you interpret the response to that treatment.

The results of the study demonstrated that PRP injections provided no improvement in the healing of rotator cuff tears as seen on imaging nor did patients feel any improvement in their symptoms when the PRP injections were compared to simple salt water injections. Additionally, the PRP injections were associated with a greater number of adverse events such as pain at the injection site, worsening of the rotator cuff tear, and the development of a frozen shoulder.

What this study tells us is that we as providers and patients need to remain wary of any claims that these interventions provide nothing but benefit and until there is more compelling research proving their efficacy they are best to be avoided. To learn more about the treatment of rotator cuff injuries visit ohioshouldercenter.com Eric M. Parsons, M.D.

Ohio Shoulder Center for Arthroscopy Lake Orthopaedic

Associates, Inc. 36060 Euclid Ave., Suite 104 Willoughby 440-942-1050 9500 Mentor Ave., Suite 210

Mentor 440-352-1711 www.ohioshouldercenter.com