Biologic Injection Therapy for Shoulder Disorders: A Narrative Review Comparing Platelet-Rich Plasma and Bone Marrow Aspirate Concentrate.

Background and

Objectives

Shoulder disorders-including rotator cuff disease, glenohumeral osteoarthritis (GH OA), and adhesive capsulitis-are among the most prevalent musculoskeletal conditions and are frequently refractory to conservative management. Platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMAC) have attracted increasing clinical interest as regenerative alternatives to corticosteroid injection, but a comparative appraisal of these two principal biologics across the full spectrum of shoulder pathology is lacking. Materials and

Methods

This narrative review is based on structured searches of MEDLINE, Embase, Cochrane CENTRAL, and Scopus for clinical studies (randomized controlled trials [RCTs], comparative studies, and prospective series) and evidence syntheses evaluating PRP or BMAC in shoulder disorders. Studies were synthesized narratively by biologic type and disorder; no formal systematic-review or scoping-review reporting protocol was applied. Current society guidelines and consensus statements were additionally examined to position each biologic, and PRP formulation subgroups (leukocyte-rich versus leukocyte-poor) were considered.

Results

PRP has the larger shoulder-specific evidence base, supported by several RCTs and meta-analyses in rotator cuff tendinopathy and in adhesive capsulitis; however, results are heterogeneous, effect sizes are generally modest, and some trials show no advantage over saline or corticosteroid. BMAC shoulder evidence is sparse and is strongest as a biological augment to rotator cuff repair (supported chiefly by a case-controlled study) rather than as a standalone injection; standalone shoulder BMAC RCTs are essentially absent. No published RCT directly compares PRP with BMAC for a shoulder disorder; the only direct randomized head-to-head comparison available is in knee osteoarthritis, where the two were reported to be equivalent at two years. Where PRP formulation was examined, leukocyte-poor preparations were associated with better structural and pain outcomes and leukocyte-rich preparations with functional gains in the surgical setting; current society guidance (e.g., the 2025 American Academy of Orthopaedic Surgeons [AAOS] rotator cuff guideline) does not endorse routine PRP use, and BMAC is not yet incorporated into shoulder guideline recommendations.

Conclusions

PRP rests on a larger but still heterogeneous evidence base for shoulder disorders, whereas BMAC is biologically promising but clinically under-evidenced in the shoulder. Neither biologic is established as superior. Standardized, shoulder-specific head-to-head RCTs-incorporating biologic characterization, structural (imaging) outcomes, and longer follow-up-represent the most important research priority in this field.