Clinical Evaluations of Intraoperative Injection of Platelet‐Rich Plasma in Arthroscopic Single‐Row Rotator Cuff Repair at 2‐Year Follow‐Up

Abstract

Background. The clinical evidence is conflicted on whether platelet-rich plasma (PRP) therapies have a positive effect on tendon healing and improved functional outcomes. Purpose. To evaluate the potentials of intraoperative injection PRP on the speed and quality of healing in patients undergoing arthroscopic repair for small to medium rotator cuff tears. Methods. A total of 86 patients scheduled for arthroscopic single-row repair of small to medium rotator cuff tears were assigned to undergo either PRP injection (PRP group) or conventional repair (control group). The PRP group ( N = 43 ) consisted of patients who received an intraoperative injection of liquid PRP. The control group ( N = 43 ) consisted of patients who did not receive that treatment. The visual analogue scale (VAS) for pain before treatment and at 1, 14 days, 3, 6, and 24 months after surgery were recorded. The clinical outcomes were assessed by the University of California, Los Angeles (UCLA) and Constant scores before treatment and at 3, 6, and 24 months after surgery and magnetic resonance imaging or ultrasound examination at 24 months. Patient satisfaction and retear rate were also assessed. Results. No statistical differences in baseline characteristics such as age, gender, dominant arm, and tear size were observed between the two groups ( P > 0.05 ). For the PRP group, the mean operation time was 40.22 minutes, and for the control group, the mean operation time was 36.3 minutes. There was a statistically significant difference ( P = 0.036 ). After surgery, all VAS measurements significantly decreased over time until final follow-up in both groups. No significant difference between the 2 groups was found for any VAS pain measurement at any time point except for the VAS at 1 day postoperatively, which was significantly lower in the PRP group ( 2.39 ± 1.03 ) than that in the control group ( 3.21 ± 1.85 ) ( P = 0.014 ). Analysis of the PRP and control groups demonstrated a statistically significant improvement in UCLA and Constant scores from baseline to the 3-, 6-, and 24-month follow-up assessments ( P < 0.05 ). However, no significant intergroup differences were observed in the clinical scores between the three follow-up time points ( P > 0.05 ). At the 24-month follow-up, patient satisfaction rates reached 95.65% and 93.48% for the PRP and control groups, respectively. The retear rate of the PRP group (2/43, 4.65%) was lower than that of the control group (6/43, 13.95%). Conclusions. Although the pain at 1 day after surgery and the retear rate in the PRP group were significantly lower than those in the control group, the liquid PRP injection did not promote better clinical outcomes at the 2-year follow-up.

Effect of Platelet-Rich Plasma Dosing for Healing after Arthroscopic Cuff Repair Compared with Surgery Alone: A Systematic Review and Meta-Analysis

“…A total of 686 patients were included, with sample sizes ranging from 42 to 102, a mean age ranging from 54 to 64 yr, and a mean follow-up ranging from 12 to 60 months. Single-row repairs were used in four studies (30,(34)(35)(36), and double-row repairs were performed for the remaining studies (29,(31)(32)(33)37,38).…”

“…Most studies used leucocyte-poor PRP (29,(31)(32)(33)(35)(36)(37)(38). Four studies used platelet concentrations of approximately 5 Â 10 5 cells•μL −1 (29,30,36,37), and six studies reached platelet concentrations of approximately 10 6 cells•μL −1 (31)(32)(33)(34)(35)38). A liquid application formula was used in six studies (29,(34)(35)(36)(37)(38), whereas gel (31)(32)(33) and membrane (30) were preferred for the others.…”

“…Four studies used platelet concentrations of approximately 5 Â 10 5 cells•μL −1 (29,30,36,37), and six studies reached platelet concentrations of approximately 10 6 cells•μL −1 (31)(32)(33)(34)(35)38). A liquid application formula was used in six studies (29,(34)(35)(36)(37)(38), whereas gel (31)(32)(33) and membrane (30) were preferred for the others. PRP was applied as a single dose at the end of the aRCR, except for two studies where US-guided injection was performed postoperatively (29,38).…”

Effect of platelet-rich plasma scaffolding combined with osteochondral autograft transfer for full-thickness articular cartilage defects of the femoral condyle

“…For each preparation, 50 ml of blood was collected from the median cubital vein using a 50-gauge needle, ensuring that the ratio of blood to anticoagulant was 9:1. PRP was prepared using a standard collection program during the surgery as described previously [8]. The collected blood was transferred to a separation tube (Weigao New Polymer Materials Co., Ltd) and centrifuged twice: once to separate the erythrocytes and subsequently to concentrate the platelets (378 × g for 10 min each).…”

Editorial Commentary: Leukocyte-Poor Platelet-Rich Plasma Decreases Retear Rate in Arthroscopic Rotator Cuff Repair: Platelet-Rich Plasma Type Matters

“…Adding to the PRP controversy is a recent study by Li et al 3 that similarly found a lower retear rate at 2-year follow-up after RCR in small-and medium-sized tears augmented with PRP. Yet, they used a leukocyte-rich PRP with >6Â platelet and leukocyte concentration.…”