Glenohumeral Platelet-Rich Plasma Injections in the Sports Medicine Clinic- SOMOS 2025

r robins, m defoor, m mcdermott s davidson, t dekker

Abstracted accepted for a rapid-fire presentation at the 2025 Society of Military Orthopaedic Surgeons Annual Meeting.

INTRODUCTION: Shoulder pain is a common complaint in military and sports medicine, frequently arising from conditions such as rotator cuff strain and tendinosis, partial-thickness tears, adhesive capsulitis, and early osteoarthritis. These disorders can significantly impair athletic performance and daily function, and are often challenging to manage with conventional therapies. In recent years, leukocyte poor platelet-rich plasma (LP-PRP) has gained attention for its potential to enhance tissue healing and modulate inflammation in musculoskeletal conditions.  While its application has been well-documented in specialized orthopedic and surgical settings, less is known about its use and effectiveness in a military general sports medicine setting, where patients present with a broad spectrum of activity levels and injury chronicity.  This case series aims to report patient reported outcomes (PROs) on patients undergoing a series of 3 LP-PRP injections utilized for various shoulder pathologies that present in a military sports medicine setting.

METHODS: Eighty-seven patient underwent a series of 3 injections of LP-PRP (Arthrex ACP) over a period of 3 weeks.  All patients utilized the Military Orthopaedic Tracking Injuries and Outcomes Network (MOTION) patient reported outcomes (PROs) database to record their response to treatment prior to injection, 6 weeks, 12 weeks, 6 months, and 1 year following injection.  Functional outcomes were recorded with ASES, SANE, and PROMIS Physical Function (PF) outcomes measures.  Pain was evaluated with PROMIS Pain Interference (PI) and Department of Veterans Affairs Visual Pain Rating Scale (DVPRS). Numeric variables for each PRO were expressed as mean (±SD) and discrete outcomes as absolute and relative (%) frequencies. Normality and heteroskedasticity of continuous data were assessed with Shapiro-Wilk and Levene’s test respectively. Continuous outcomes were compared with Anova, Welch Anova or Kruskal-Wallis tests according to data distribution. Discrete outcomes were compared with chi-squared or Fisher’s exact test accordingly. The alpha risk was set to 5% and two-tailed tests were used.  Finally, univariate analysis utilizing the Kruskal test allowed for comparison of survey score medians across collected survey time points. The alpha risk was set to 0.05.  Statistical analysis was performed with EasyMedStat (version 3.42).

RESULTS: ASES scores improved from 59.6 (CI±16.57) prior to injection to 72.26 (CI±20.1) at 12 months.  Multivariate analysis identified LP-PRP was associated with higher ASES scores at 12 weeks (β=10.4, [2.09 ; 18.72], p= 0.0145), 6 months (β=9.65, [0.86 ; 18.45], p= 0.0317), and 1 year (β=12.65, [3.86 ; 21.45], p= 0.0051).  SANE scores also showed improvement from 59.22 (CI±20.75) to 69.85 (CI±17.97) at 12 months, with multivariate analysis demonstrating treatment associated with higher scores at 12 weeks (β=11.92, [1.62 ; 22.22], p= 0.0235), 6 months (β=12.39, [2.45 ; 22.32], p= 0.0148), and 1 year (β=10.63, [0.13 ; 21.13], p= 0.0473).  PROMIS PF in multivariate analysis were associated with higher values only at 6 months (β=4.56, [0.09 ; 9.03], p= 0.0457).  For pain, DVPRS improved from 4.84 (CI±1.98) to 3.1 (CI±2.29) at 12 weeks with a final mean value of 3.7 (CI±2.18).  Multivariate analysis found improved pain scores at all time points [6 weeks (β=-1.19, [-2.38 ; -0.01], p= 0.0483), 12 weeks (β=-1.74, [-2.75 ; -0.72], p= 0.001), 6 months (β=-1.61, [-2.59 ; -0.63], p= 0.0015), and 12 months (β=-1.14, [-2.15 ; -0.12], p= 0.0293)].  PROMIS PI did not show any decrease in pain scores at any time points with multivariate analysis [6 weeks (β=-0.09, [-5.11 ; 4.93], p= 0.9728), 6 months (β=-4.03, [-8.57 ; 0.51], p= 0.0807), 12 months (β=-3.6, [-7.97 ; 0.77], p= 0.1046)]. Of note, the “MOTION Readiness” score completed by 9 active-duty members improved from 66.56 (CI±23.13), peaking between 3-6 months (84.5 (CI±13); 85.1 (CI±8.95)) before settling at 72.42 (CI±24.96) at 12 months, with multivariate analysis not possible due to the low number of respondents. 

DISCUSSION/CONCLUSION: LP-PRP demonstrated continuous improvement of function and decreased pain over 12 months with common shoulder ailments that present in a military sports medicine population. In addition, maintenance of improved pain and function can be anticipated throughout the 12 months following treatment.