Injectable platelet-rich fibrin versus subacromial corticosteroid injection in the management of symptomatic partial thickness rotator cuff tears

BACKGROUND: Partial thickness rotator cuff tears (PTRCT) are a leading cause of refractory shoulder pain. Subacromial corticosteroid (CS) injection provides short-term relief but may compromise tendon integrity. Injectable platelet-rich fibrin (iPRF), a second-generation autologous biologic, theoretically promotes healing through sustained growth factor release. OBJECTIVE: To compare the efficacy of iPRF with CS injection on pain and shoulder function over 12 months in symptomatic PTRCTs. METHODS: In this study 69 patients with PTRCT confirmed by magnetic resonance imaging (MRI) were prospectively allocated to a single subacromial injection of iPRF (group 1, n = 37) or 40 mg methylprednisolone with 1% lignocaine (group 2, n = 32). The iPRF was prepared by centrifuging 10 mL of autologous blood at 700 rpm for 3 min. Visual analogue scale (VAS) and disabilities of the arm, shoulder and hand (DASH) scores were recorded at day 0 and at 1, 6 and 12 months. Of the patients 3 in the iPRF arm were lost to follow-up so that 34 and 32 patients, respectively could be analyzed. RESULTS: Baseline demographics and scores were comparable (p > 0.05). At 1 month, both groups showed comparable improvement (VAS 4.09 vs. 3.69; p = 0.23). By 6 and 12 months, iPRF showed significantly superior outcomes: VAS at 12 months 1.81 ± 1.24 vs. 5.18 ± 1.46 and DASH 18.4 ± 9.8 vs. 44.9 ± 9.8 (both p < 0.001). Responder rate (≥ 50% VAS reduction) at 12 months was 97.1% in iPRF vs. 6.3% in CS. No major complications occurred. CONCLUSION: A single subacromial injection of iPRF produces durable, progressive improvement in pain and shoulder function in patients with PTRCTs, outperforming corticosteroid injection at midterm and long-term follow-up. The use of iPRF offers a safe, autologous, regenerative alternative to corticosteroids.