PONE-D-21-06594

Platelet-rich plasma for rotator cuff tendinopathy: A systematic review and

meta-analysis

PLOS ONE

Dear Dr. Sazlina,

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Academic Editor

PLOS ONE

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Reviewers' comments:

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Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

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Reviewer #1: Rotator cuff (RC) tendinopathy, manifested by shoulder pain and dysfunction, is common, and platelet-rich plasma (PRP) is a popular option in clinics to treat the RC tendinopathy. Although there are many studies to assess the efficacy of PRP treatment on RC pain and function, it is still a matter of debate as to whether PRP treatment is more beneficial than other regular treatment modalities such as physical therapy and corticosteroid injection. The authors of this study performed a systematic review and meta-analysis to assess clinical trials of PRP treatment on RC tendinopathy. They focused on the central question – “How effective are PRP treatment in reducing shoulder pain and improving shoulder function?”

The authors performed extensive search on the literature from 1970 to 2020, found 548 relevant articles, and eventually identified 8 qualified articles, which were randomized controlled trials (RCT). The criteria for the selection of the previous studies are clearly defined.

Then they performed meta-analysis on these eight RCT studies to assess the study quality, the primary outcomes – VAS score, or NRPS score; and secondary outcomes - CSS, ASES, and DASH. The main finding of this meta-analysis is that there was no improvement in pain from PRP treatment compared to control interventions in early treatment time point (3 weeks), but significant improvement in pain was revealed at 6 and 12 months after PRP treatment.

Overall, the authors performed this meta-analysis of previous RCTs rigorously and as a result, their findings are deemed to be reasonable. The manuscript is well written with all necessary details provided so that the readers can evaluate the quality of their analysis of literature in general and those RCTs included in this report in particular.

In the “Limitation” section, the authors state that because of small sample size and lack of - CSS unpublished negative studies, “the outcomes reported in this meta-analysis should be interpreted with caution.” This reviewer agrees with this statement completely. In fact, even the highly selected 8 RCTs were not homogenous at all (I square > 90%, page 19). The heterogeneity among the studies in this report can also include PRP-related factors - the technique of preparation, use of activating agents, volume of PRP injected, the frequency of PRP injection, and those patient-related factors such as different stages of RC tendinopathy. The authors may wish to discuss these factors in more details so that readers can appreciate the complexity of a clinical trial more with PRP treatment on RC tendinopathy.

Reviewer #2: The article is of scientific interest and in line with the aims of the journal. The authors guidelines have been respected and the manuscript does not require a revision of the English language by a native speaker. The literature search was adequately carried out and the results of the studies were described in full.

The only concern are the tables and figures that in the document I have are of very bad quality and it is not possible for me to judge them.

Therefore you need to increase the quality of tables and figures before proceeding with publication.

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Reviewer #1: No

Reviewer #2: No

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Platelet-rich plasma for rotator cuff tendinopathy: a systematic review and

meta-analysis

PONE-D-21-06594R1

Dear Dr. Sazlina,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

Sherief Ghozy, M.D., Ph.D. candidate

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: