Clinical and Structural Evaluations of Rotator Cuff Repair With and Without Added Platelet-Rich Plasma at 5-Year Follow-up: A Prospective Randomized Study

Abstract

Background: Platelet-rich plasma (PRP) has been studied with the objective of reducing the retear rate and improving functional outcomes after rotator cuff repair. Only one study to date has reported its midterm effect. Hypothesis: PRP promotes better functional and structural results in arthroscopic rotator cuff repair. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: All patients underwent arthroscopic single-row repair of small to medium supraspinatus tears. At the end of the surgical procedure, liquid PRP prepared by apheresis with autologous thrombin was applied in the tendon-to-bone interface in the PRP group. The outcomes were assessed by the University of California, Los Angeles (UCLA) and Constant scales and the visual analog scale (VAS) for pain at 6, 12, 24, and 60 months after surgery and magnetic resonance imaging at 12 and 60 months. Results: Of 54 patients initially randomized, we analyzed the clinical outcomes in 51 (25 control, 26 PRP) and the structural outcomes in 44 (22 each group). At 60-month follow-up, the mean UCLA scores were 32.5 ± 3.8 and 32.1 ± 4.6 in the control and PRP groups, respectively ( P = .992). The mean Constant scores were 82.0 ± 9.5 in the control group and 82.1 ± 11.0 in the PRP group ( P = .699). The mean VAS scores were 1.4 ± 1.8 and 1.5 ± 2.1 in the control and PRP groups, respectively ( P = .910). None of the clinical assessments at 6, 12, and 24 months in either group produced statistically significant differences, and both groups showed significant improvements throughout the follow-up time in the 3 evaluations ( P < .001). The control group exhibited 1 full-thickness retear (Sugaya type IV) and 11 partial-thickness retears (Sugaya type III), while the PRP group had 7 partial-thickness retears (Sugaya type III). The overall number of retears did not differ between groups ( P = .203). Conclusion: PRP obtained by apheresis and applied in liquid form with the addition of thrombin at the end of single-row repair of supraspinatus tears did not promote better clinical or structural results at 60-month follow-up. Registration: NCT01029574 ( ClinicalTrials.gov identifier)

Preliminary Clinical Outcomes Following Biologic Augmentation of Arthroscopic Rotator Cuff Repair Using Subacromial Bursa, Concentrated Bone Marrow Aspirate, and Platelet-Rich Plasma

“…9,10,12,42,43 Even recent meta-analyses of randomized controlled trials have reported mixed results, with some showing decreased failure-to-heal rate for small-to medium-sized tears as well as decreased re-tear rates for large tears treated with PRP, 9,44 and others finding no difference in outcome scores and structural healing rates. 42,45 A study by Malavolta et al 46 found that PRP application did not significantly improve clinical outcomes, pain, and structural healing in 51 prospectively randomized patients undergoing rotator cuff repair at 5-year followup. Similar to our results, Randelli et al 47 reported short-term benefits following repair augmentation using PRP, including significantly lower pain scores 1 month after surgery and greater functional improvement at 3-month follow-up.…”

A Randomized Controlled Trial of the Treatment of Rotator Cuff Tears with Bone Marrow Concentrate and Platelet Products Compared to Exercise Therapy: A Midterm Analysis

“…The growth factor, cytokine, and chemokine profiles seen in PRP, PL, and BMC are different and likely work synergistically in encouraging healing [55][56][57][58]. Multiple studies have evaluated utilizing PRP in arthroscopic repair of fullthickness supraspinatus tears without clear benefit based on clinical outcome scores but with decreased rates of failure-to-heal [59,60]. There is only one case report on treatment of a full-thickness supraspinatus tear with percutaneous PRP injection.…”

Effects of applying platelet-rich plasma during arthroscopic rotator cuff repair: a systematic review and meta-analysis of randomised controlled trials

“…The full text of the remaining 14 citations was screened, which revealed three articles that dealt with the use of plasma-rich fibrin, one that involved diagnosis not based on MRI or sonography findings, one that dealt with partial-thickness tear, and two that involved PRP application through sonography-guided injection postoperatively. Finally, seven articles were selected for this systematic review and meta-analysis [30][31][32][33][34][35][36] (Fig. 1).…”

“…The risk of deviations from intended interventions was low in four studies [30][31][32]36 and uncertain in three studies [33][34][35] . Two studies were identified as having uncertain risk 31,36 and was identified as having high risk 32 related to missing outcome data. Furthermore, one study was high risk in terms of outcome measurement 35 .…”

“…Six studies [30][31][32][33][34]36 were identified as having low risk in the randomisation process, and one was identified as having uncertain risk 35 . The risk of deviations from intended interventions was low in four studies [30][31][32]36 and uncertain in three studies [33][34][35] . Two studies were identified as having uncertain risk 31,36 and was identified as having high risk 32 related to missing outcome data.…”