Non-operative orthobiologic use for rotator cuff disorders and glenohumeral osteoarthritis: A systematic review

J Back Musculoskelet Rehabil. 2021;34(1):17-32. doi: 10.3233/BMR-201844.


Background: Shoulder pain from rotator cuff pathology and glenohumeral osteoarthritis is a common entity encountered in musculoskeletal practices. Orthobiologic agents are being increasingly used as a treatment option and understanding their safety and efficacy is necessary.

Objective: To systematically evaluate the available evidence for orthobiologic use in rotator cuff and glenohumeral pathology.

Methods: A systematic review was undertaken following PRISMA guidelines. Randomized clinical trials (RCTs) and prospective cohort studies evaluating non-operative treatment with prolotherapy, platelet-rich plasma (PRP), or medicinal signaling cells (MSCs) for rotator cuff pathology and glenohumeral osteoarthritis were included. Bias risk assessments used were the Cochrane tool and Newcastle-Ottawa score.

Results: The search yielded 852 potential articles, of which 20 met the inclusion criteria with a breakdown of 5 prolotherapy, 13 PRP, and 2 MSC. Sixteen studies were RCTs and 4 were cohort studies. Six studies were deemed "low risk of bias or good quality". Efficacy results were mixed, and no serious adverse events were reported from orthobiologic treatment.

Conclusions: Orthobiologics offer a relatively safe management option with inconclusive evidence for or against its use for rotator cuff pathology. No studies on glenohumeral osteoarthritis met the inclusion criteria. Adoption of standardized preparation reporting and consistent use of functional outcome measures is imperative for future studies to consider.

Keywords: Musculoskeletal; medicinal signaling cells; orthobiologics; platelet-rich plasma; prolotherapy; rotator cuf; sports medicine.

Publication types

  • Systematic Review

MeSH terms

  • Humans
  • Osteoarthritis / physiopathology
  • Osteoarthritis / therapy*
  • Platelet-Rich Plasma*
  • Prolotherapy*
  • Prospective Studies
  • Rotator Cuff Injuries / physiopathology
  • Rotator Cuff Injuries / therapy*
  • Shoulder Pain / physiopathology
  • Shoulder Pain / therapy*
  • Treatment Outcome