Effect of arthroscope combining platelet-rich plasma in treatment of adherent periarthritis of shoulder

doi:10.3877/cma.j.issn.1674-134X.2023.06.002

Abstract

Abstract:

Objective

To investigate the effect of arthroscopic release combined with platelet-rich plasma (PRP) on the expression of transforming growth factor β(TGF-β) and matrix metalloproteinase 2 (MMP-2) in the treatment of adhesive periarthritis of shoulder.

Methods

A total of 112 patients with adhesive periarthritis of shoulder admitted to Department of Orthopedics, Zhuhai People's Hospital from January 2021 to July 2022 were selected. Inclusion criteria: diagnosis of periarthritis of shoulder; non-surgical treatment for at least six months without improvement; aged from 50 to 70 years. Exclusion criteria: secondary periarthritis of shoulder; combing with rotator cuff injury, bone fracture or dislocation; vital organ dysfunction; endocrine diseases.The patients were divided into two groups by random number table, 56 cases in each group. The experimental group were treated by shoulder arthroscopic release and PRP injection, and the control group were treated only with shoulder arthroscopic release. The serum MMP-2 and TGF-β were compared between the two groups before operation, three and six months after operation, and the visual analog scale (VAS) before operation, one, three and six months after operation, the Constant score, American Shoulder Elbow Surgeons(ASES)score of shoulder joint and the range of motion (ROM) of shoulder joint were compared between the two groups before operation and three and six months after operation by analysis of variance and t test.

Results

There was no significant difference in gender, age or other general data between the two groups (all P>0.05). VAS score was significantly decreased at one, three and six months after operation, while Constant score, ASES score were increased at three and six months after operation (F=151.25, 119.37, 1603.87, 1488.35, all P<0.001), and ROM activity also improved significantly (anteflexion F=957.80, 803.17, internal rotation F=755.46, 1024.99, abduction F=506.43, 626.74, all P<0.001), the difference was statistically significant.Compared with the last follow-up between the two groups, the VAS score, the Constant score, the ASES score in the experimental group were significantly improved (t=3.223, 4.612, 3.583, all P<0.05), and ROM activity was also significantly improved(forward flexion t=3.487, internal rotation t=5.101, abduction t=3.114, all P<0.001), the differences were statistically significant.At three and six months after operation, the levels of TGF-β and MMP-2 in two groups were lower than before operation(F=650.28, 784.41, 506.37, 740.33, all P<0.05), and the levels of TGF-β and MMP-2 in experimental group were lower than those in control group(t=2.656, 2.723, 2.736, 2.941, all P<0.05), the differences were statistically significant. At the last follow-up, there was one case of recurrent adhesion in the experimental group, and fourcases of recurrent shoulder adhesion in the control group, all of which were relieved after PRP injection.

Conclusion

The effect of shoulder arthroscopic surgery combined with PRP in the treatment of adhesive shoulder periarthritis is better than that of arthroscopicdebridementalone, which can not only rapidly reduce pain and functional recovery, but also reduce the degree of inflammation and the risk of recurrence in patients, and can be used as a treatment for the recurrence of adhesions after release

Key words: Shoulder, Arthroscope, Platelet-rich plasma, Periarthritis, Transforming growth factor beta, Matrix metalloproteinases

Jianfeng Ouyang, Bingquan Li, Yongheng Ye, Shaoyu Hu, Yang Xiang. Effect of arthroscope combining platelet-rich plasma in treatment of adherent periarthritis of shoulder[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(06): 765-772.

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References 27

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组别Groups	例数Case number	年龄[岁，(±s)]Age (year)	性别[例(%)]Gender		病程[月，(±s)]Duration(month)	患侧[例(%)]Affected side
组别Groups	例数Case number	年龄[岁，(±s)]Age (year)	男Male	女Female	病程[月，(±s)]Duration(month)	左Left	右Right
实验组Experimental group	56	59.5±5.4	36(64.3)	20(35.7)	8.3±1.7	32(57.1)	24(42.9)
对照组Control group	56	58.8±5.3	32(57.1)	24(42.9)	7.98±1.7	29(51.8)	27(48.2)
统计值Statistical value		t＝1.501	χ²＝0.599		t＝0.949	χ²＝0.324
P值		>0.05	>0.05		>0.05	>0.05

组别Groups	例数Case number	年龄[岁，(±s)]Age (year)	性别[例(%)]Gender		病程[月，(±s)]Duration(month)	患侧[例(%)]Affected side
组别Groups	例数Case number	年龄[岁，(±s)]Age (year)	男Male	女Female	病程[月，(±s)]Duration(month)	左Left	右Right
实验组Experimental group	56	59.5±5.4	36(64.3)	20(35.7)	8.3±1.7	32(57.1)	24(42.9)
对照组Control group	56	58.8±5.3	32(57.1)	24(42.9)	7.98±1.7	29(51.8)	27(48.2)
统计值Statistical value		t＝1.501	χ²＝0.599		t＝0.949	χ²＝0.324
P值		>0.05	>0.05		>0.05	>0.05

组别Groups	例数Case number	手术前Before operation	术后1个月One month after operation	术后3个月Three months after operation	术后6个月Six months after operation	F值	P值
实验组Experimental group	56	6.38±0.74	3.31±0.50^a	2.12±0.31^a	1.42±0.43^a	933.89	<0.001
对照组Control group	56	6.58±0.75	4.09±0.39^a	2.74±0.25^a	1.76±0.18^a	1 483.58	<0.001
t值		0.849	5.531	7.032	3.223
P值		>0.05	<0.001	<0.001	0.03

组别Groups	例数Case number	手术前Before operation	术后1个月One month after operation	术后3个月Three months after operation	术后6个月Six months after operation	F值	P值
实验组Experimental group	56	6.38±0.74	3.31±0.50^a	2.12±0.31^a	1.42±0.43^a	933.89	<0.001
对照组Control group	56	6.58±0.75	4.09±0.39^a	2.74±0.25^a	1.76±0.18^a	1 483.58	<0.001
t值		0.849	5.531	7.032	3.223
P值		>0.05	<0.001	<0.001	0.03

组别Groups	例数Case number	手术前Before operation	术后3个月Three months after operation	术后6个月Six months after operation	F值	P值
实验组Experimental group	56	51.0±3.5	74.3±1.4^a	83.5±1.5^a	151.25	<0.001
对照组Control group	56	49.8±2.8	72.0±1.3^a	81.5±1.0^a	119.37	<0.001
t值		1.187	5.351	4.612
P值		>0.05	<0.001	<0.001

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