Introduction
Musculoskeletal pain affects the bones, muscles, ligaments, tendons, and nerves. Among them, pains in the tendons or ligaments are often caused by injuries, including sprains, overuse, or repetitive motions. Recently, several researches have reported that polydeoxyribonucleotide (PDRN) has an effect in musculoskeletal pain, especially in tendons or ligaments pain, such as rotator cuff tendinopathy, lateral epicondylitis, pes anserine, and plantar fasciitis. Polydeoxyribonucleotide (PDRN) is a compound of deoxyribonucleotide polymers of different lengths ranging from 50 to 2,000 base pairs and nucleosides derived from salmon sperm. To our knowledge, however, the effects of PDRN in patients with tendon or ligament pain have not been known accurately. To evaluate the effectiveness of PDRN injection in patients with tendon or ligament pain, therefore, we performed a meta-analysis of all available clinical studies of PDRN treatment in patients with tendon or ligament pain.
Methods
Electronic literature search of PubMed, Embase, SCOPUS, and Cochrane Library databases checked of all articles on PDRN for patients with tendon or ligament pain published in the English language till January 31. 2020. Articles were included based on the following criteria: 1) patients’ pain was induced by tendon or ligament lesions; 2) “injection of PDRN near the lesion” was used to manage the pain; 3) the pain levels were evaluated before and after PDRN treatment; and 4) studies involving human subjects. The search identified 262 citations.
Results
One RCT study and three retrospective observational studies were included. The pain due to tendon or ligament disorders showed significant improvement after PDRN injection (SMD = -1.43, 95% CI = -1.80 to -1.06, P < 0.00001). In the sub-analysis of patients with rotator cuff tendinopathy, rotator cuff tendinopathy-induced pain improved significantly (SMD = -2.34, 95% CI = -3.61 to -1.07, P = 0.0003) after PDRN injection. However, there was no difference in an analysis of shoulder pain and disability index (SPADI) and strength of shoulder abduction in patients with rotator cuff tendinopathy (SPADI: SMD = 1.16, 95% CI = -1.20 to 3.52, P = 0.34, Strength of shoulder abduction: SMD = 0.42, 95% CI = -0.03 to 0.88, P = 0.07).
Conclusion
Effective pain-relief was achieved in patients with tendon or ligament disorders after PDRN injection. Our study is first meta-analysis that analyzed the effect of PDRN injection in the pain reduction of tendon or ligament disorders, and rotator cuff tendinopathy. However, our meta-analysis was limited due to the limited number of included trials and sample size. In the future, therefore, meta-analysis with a larger number of clinical trials would be warranted. |
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Characteristics of included studies.
Results of analysis of visual analog scale (VAS) changes compared to control group after polydeoxyrionucleotide injection in patients with tendon or ligament pain.
Results of analysis of visual analog scale (VAS) changes after polydeoxyrionucleotide (PDRN) injection in patients with tendon or ligament pain. (A). At 12 weeks after PDRN injection, (B). At 4-6 weeks after PDRN injection.
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