Author Reply to “Regarding ‘Platelet‐Rich Plasma in Patients With Partial‐Thickness Rotator Cuff Tears or Tendinopathy Leads to Significantly Improved Short‐Term Pain Relief and Function Compared With Corticosteroid Injection: A Double‐Blind Randomized Controlled Trial’”
Bibliographic record
Abstract
We thank Dr. Flatow1Flatow E.L. Regarding "Platelet-rich plasma in patients with partial-thickness rotator cuff tears or tendinopathy leads to significantly improved short-term pain relief and function compared with corticosteroid injection: A double-blind randomized controlled trial.".Arthroscopy. 2021; 37: 1375-1376Scopus (2) Google Scholar for his interest in our study, entitled “Platelet-Rich Plasma in Patients With Partial-Thickness Rotator Cuff Tears or Tendinopathy Leads to Significantly Improved Short-Term Pain Relief and Function Compared With Corticosteroid Injection: A Double-Blind Randomized Controlled Trial.”2Kwong C.A. Woodmass J.M. Gusnowski E.M. et al.Platelet- rich plasma in patients with partial thickness rotator cuff tears or tendinopathy leads to significantly improved short-term pain relief and function compared to corticosteroid injection: A double-blind randomized controlled trial.Arthroscopy. 2021; 37: 510-517Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar His point regarding the inclusion of patients with previous corticosteroid injections (CSIs) is valid and a factor to consider when interpreting the results of our study. This study was performed in a Canadian tertiary referral center, and some factors were pragmatic by design. In this context, all patients must be referred by a primary care physician and therefore many had tried some form of nonoperative management such as one or more of the following: physical therapy/home exercise program, oral analgesics, or CSIs. Platelet-rich plasma (PRP) injections represent a significant out-of-pocket cost in our health care system and thus CSIs are generally prescribed before the expensive alternative of PRP. The patients included in this study represented the typical rotator cuff patient at our institution. For these reasons, we believed that if we were to exclude all patients who had had previous CSIs, the cohort would not be representative of our practice setting. Furthermore, patient recruitment could have been prolonged beyond a feasible timeline. Upon retrospective review of our data, the mean number of corticosteroid injections before intervention was 0.86 in the CSI and 0.80 in the PRP group (P = .77). In addition, 51% of patients in the control group and 46% in the PRP group were receiving a first-time injection, and only 4 of 47 (8.5%) patients in the control group and 3 of 52 (5.8%) in the PRP group had received 3 previous injections. Overall, 72 of 99 (73%) had received 1 or fewer injections before study intervention. Baseline American Shoulder and Elbow Surgeons, visual analog scale, and Western Ontario Rotator Cuff Index scores did not differ based on number of previous CSIs. At this time, subgroup analysis of those with previous injections versus those without was not performed, as the study was not powered to detect this effect. Adjusting the inclusion criteria of future studies will be of particular interest as practice patterns change and mounting evidence suggests possible deleterious effects of CSI.3Desai V.S. Camp C.L. Boddapati V. Dines J.S. Brockmeier S.F. Werner B.C. Increasing numbers of shoulder corticosteroid injections within a year preoperatively may be associated with a higher rate of subsequent revision rotator cuff surgery.Arthroscopy. 2019; 35: 45-50Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar,4Weber A.E. Trasolini N.A. Mayer E.N. et al.Injections prior to rotator cuff repair are associated with increased rotator cuff revision rates.Arthroscopy. 2019; 35: 717-724Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar We hope this reply provides some insight into the context of our experimental design. As with all studies, one must scrutinize the applicability of the methodology and results to their own clinical setting before implementing change based on new literature. Despite the limitations described in the manuscript and so perceptively identified by Dr. Flatow, we believe our paper nonetheless provides valuable insight into the potential benefits and limitations of PRP for the use of partial-thickness rotator cuff tears and tendinopathy. Download .pdf (6.04 MB) Help with pdf files ICMJE author disclosure forms
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.072 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.003 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.003 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.003 | 0.001 |
| Research integrity | 0.030 | 0.028 |
| Insufficient payload (model declined to judge) | 0.010 | 0.008 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".