Platelet-rich plasma as a potential prophylactic measure against frozen shoulder in an in vivo shoulder contracture model

Oscar Feusi; Agnieszka Karol; Thea Fleischmann; Brigitte von Rechenberg; Samy Bouaicha; Clément M L Werner; Thorsten Jentzsch

doi:10.1007/s00402-020-03617-x

Platelet-rich plasma as a potential prophylactic measure against frozen shoulder in an in vivo shoulder contracture model

Arch Orthop Trauma Surg. 2022 Mar;142(3):363-372. doi: 10.1007/s00402-020-03617-x. Epub 2020 Oct 19.

Authors

Oscar Feusi¹, Agnieszka Karol², Thea Fleischmann³, Brigitte von Rechenberg², Samy Bouaicha^{4

5}, Clément M L Werner^#⁴, Thorsten Jentzsch^#^{4

5}

Affiliations

¹ Department of Trauma, University Hospital Zurich, University of Zurich, Zurich, Switzerland. oscar.feusi@bluewin.ch.
² Musculoskeletal Research Unit (MSRU) Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, Zurich, Switzerland.
³ Division of Surgical Research, Centre for Clinical Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
⁴ Department of Trauma, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
⁵ Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.

^# Contributed equally.

Abstract

Introduction: Frozen shoulder (adhesive capsulitis) is a common painful and functionally-limiting disease affecting around 2% of the population. So far, therapeutic options are limited and often unsatisfactory. Platelet-rich plasma (PRP) has been used as a treatment option in other orthopedic diseases since it contains growth factors that stimulate tissue repair. So far, the effect of PRP on frozen shoulder lacks evidence. We hypothesized that PRP may be valuable in the prophylaxis and treatment of secondary frozen shoulder due to capsular remodeling.

Materials and methods: An experimental study of an in vivo frozen shoulder model was conducted. Twenty Sprague-Dawley rats underwent surgery in which the body of the scapula was connected to the humerus with a high-strength suture. Two groups of 8 weeks survival time were allocated; a treatment group with one intraoperative injection of PRP into the glenohumeral joint (n = 10) and a control group without PRP (n = 10). The primary outcome was the structural change in the posterior synovial membrane of the posterior and inferior part of the glenohumeral joint using a semi-quantitative grading from 0 (lowest) to 3 (highest).

Results: The posterior synovial membrane structural changes were significantly lower in the PRP group (median = 1 [interquartile range (IQR) = 0-1]) compared to controls (median = 2 [IQR = 1-3]) (p = 0.028). There were no differences for the remaining synovial membrane changes and fibrous capsule responses between groups.

Conclusions: In this in vivo shoulder contracture model, PRP injections seem to reduce the histological severity grade of some parts (i.e., posterior synovial membrane changes) of the secondary frozen shoulder without causing any side effects. It may be considered to investigate this effect further in future studies as a potential prophylaxis of secondary frozen shoulder (e.g., in operated or immobilized shoulders) or as a treatment option for patients with frozen shoulder in the early stage.

Keywords: Adhesive capsulitis; Frozen shoulder; Infiltration; Injection; Platelet-rich plasma; Shoulder.

MeSH terms

Animals
Bursitis* / therapy
Contracture* / prevention & control
Humans
Platelet-Rich Plasma*
Rats
Rats, Sprague-Dawley
Shoulder
Shoulder Joint*