Arthroscopy - 2026-08-01 - Journal Article; Systematic Review; Meta-Analysis; Review
Platelet-Rich Plasma Injections for the Treatment of Rotator Cuff Pathology Have Higher Complication Rates of Adhesive Capsulitis than Alternative Injectable Therapies: A Systematic Review and Meta-analysis of Randomized Controlled Trials.
Driscoll A, Griffin S, Schreiner G, Fucaloro S, Krivicich L, Salzler M
Topics
Key Takeaway
PRP injections for rotator cuff pathology carry a significantly higher rate of adhesive capsulitis than comparator injectables (P=.01), despite equivalent overall complication rates of 9.41% vs. 10.13%.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This systematic review and meta-analysis of 19 RCTs examined complication rates of PRP versus alternative injectables (corticosteroid, saline) for rotator cuff pathology in 1,043 patients. Overall complication rates were equivalent between PRP (9.41%) and comparators (10.13%, P=.67), with no serious adverse events reported across any study. PRP was associated with a statistically higher incidence of adhesive capsulitis (P=.01), a signal that persisted across subgroup analyses by leukocyte concentration, activator use, and injection number.
Key Limitation
Nearly half of included studies reported zero complications, indicating inconsistent and likely inadequate adverse event surveillance across trials, which undermines the reliability of the pooled complication rate estimates.
Original Abstract
PURPOSE
To analyze existing literature assessing the rate and types of complications associated with platelet-rich plasma (PRP) injections compared with alternative injectable therapies for the nonoperative treatment of rotator cuff pathology.
METHODS
PubMed, Embase, Web of Science, and Cochrane databases were queried in accordance with the Preferred Reporting Items for Systematic Reviews protocol for randomized-controlled trials published prior to February 2025 that compared complications following PRP injection to a comparable injectable for rotator cuff pathology. Meta-analysis, reported in odds ratios (OR), was conducted for subgroups of comparison injection, leukocyte concentration, exogenous activator, and number of injections.
RESULTS
There were 19 studies included with a total of 1043 patients, 510 of whom received PRP injections. Nine (47%) studies reported zero complications. Across the 10 remaining studies, there were 102 total complications, 48 (47%) of which occurred after PRP injections. There was no difference in overall complication rate between the PRP (9.41%) and comparison (10.13%) groups (P = .67), though PRP patients had significantly higher rates of frozen shoulder (P = .01). The most common complications included persistent pain, frozen shoulder, worsening of tear, and bursitis. Sub-analysis of 3 studies comparing PRP to saline injections found no difference in complications (OR = 1.62 [0.27-9.79], I 2 = 35.65%, P = .06) as did the 13 studies comparing PRP to corticosteroid (OR = 0.56 [0.27-1.16], I 2 = 8.79%, P = .12), even when sub-analyzed by leukocyte concentration (OR = 0.79 [0.38-1.65], I 2 = 0.00%, P = .53), exogenous activator use (OR = 0.79 [0.38-1.65], I 2 = 0.00%, P = .53), and injection number (OR = 0.56 [0.27-1.16], I 2 = 8.79%, P = .12).
CONCLUSIONS
Results of this review suggest that PRP injections are generally safe for treating rotator cuff pathologies with a similar overall complication incidence to comparator injectables with no reports of serious events across all studies. PRP injections were more often complicated by adhesive capsulitis. The pooled complication rates for the PRP group were similar to corticosteroid and saline injections.
LEVEL OF EVIDENCE
Level II, systematic review and meta-analysis of Level I and II randomized-controlled trials.