The Effect of Delayed Injection of Leukocyte-Rich Platelet-Rich Plasma Following Rotator Cuff Repair on Patient Function: A Randomized Double-Blind Controlled Trial

Snow, Martyn; Hussain, Faisal Nazeer; Pagkalos, Joseph; Kowalski, Tomasz; Green, Marcus; Massoud, Samir N.; James, Steven

doi:10.1016/j.arthro.2019.09.026

Cited by 33 publications

(33 citation statements)

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“…The current study demonstrates that LP-PRP reduces the rate of retear and/or incomplete tendon healing after ARCR and subsequently improves patient-reported 33 15.4 vs 21.1 Zhang (2016) 40 13.3 vs 30 outcomes as compared with a control. However, it is still unclear whether LP-PRP improves the tendon healing rate when compared with LR-PRP.…”

Section: Discussionmentioning

confidence: 60%

The Effect of Platelet-Rich Plasma Leukocyte Concentration on Arthroscopic Rotator Cuff Repair: A Network Meta-analysis of Randomized Controlled Trials

et al. 2020

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Background: It is unclear whether leukocyte-poor (LP) or leukocyte-rich (LR) varieties of platelet-rich plasma (PRP) as an adjuvant to arthroscopic rotator cuff repair (ARCR) result in improved tendon healing rates. Purpose: To perform a network meta-analysis of the randomized controlled trials in the literature to ascertain whether there is evidence to support the use of LP- or LR-PRP as an adjunct to ARCR. Methods: The literature search was based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Randomized controlled trials comparing LP- or LR-PRP with a control alongside ARCR were included. Clinical outcomes, including retears and functional outcomes, were compared using a frequentist approach to network meta-analysis, with statistical analysis performed using R. The treatment options were ranked using the P-score. Results: There were 13 studies (868 patients) included, with 9 studies comparing LP-PRP with a control and 4 studies comparing LR-PRP with a control. LP-PRP was found to significantly reduce the rate of retear and/or incomplete tendon healing after fixation, even among medium-large tears; it also improved outcomes on the visual analog scale for pain, Constant score, and University of California Los Angeles score. LP-PRP had the highest P-score for all treatment groups. LR-PRP did not result in any significant improvements over the control group, except for visual analog scale score for pain. However, post hoc analysis revealed that LP-PRP did not lead to significant improvements over LR-PRP in any category. Conclusion: The current study demonstrates that LP-PRP reduces the rate of retear and/or incomplete tendon healing after ARCR and improves patient-reported outcomes as compared with a control. However, it is still unclear whether LP-PRP improves the tendon healing rate when compared with LR-PRP.

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Section: Discussionmentioning

confidence: 60%

The Effect of Platelet-Rich Plasma Leukocyte Concentration on Arthroscopic Rotator Cuff Repair: A Network Meta-analysis of Randomized Controlled Trials

et al. 2020

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“…6,10,26 Therefore, more studies are being performed on biological therapies to assist the healing of rotator cuff tendon, such as platelet-rich plasma (PRP) and plateletrich fibrin (PRF). 4,13,14,17,22,29,30 PRP is an autologous plasma produced using centrifugation and separation of whole blood, which is enriched with a higher platelet concentration than normal blood. 36 Dohan Ehrenfest et al 7 classified different platelet concentrates into 4 categories according to the content of fibrin and leukocyte: pure platelet-rich plasma, leukocyte-and platelet-rich plasma, pure PRF, and leukocyte and PRF.…”

mentioning

confidence: 99%

“… 6 , 10 , 26 Therefore, more studies are being performed on biological therapies to assist the healing of rotator cuff tendon, such as platelet-rich plasma (PRP) and platelet-rich fibrin (PRF). 4 , 13 , 14 , 17 , 22 , 29 , 30 …”

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confidence: 99%

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Application of Platelet-Rich Plasma in Arthroscopic Rotator Cuff Repair: A Systematic Review and Meta-analysis

Xue

2021

Orthopaedic Journal of Sports Medicine

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Background: It is unclear how and which factors affect the clinical efficacy of platelet-rich plasma (PRP) applied during arthroscopic rotator cuff repair. Purpose: To evaluate the clinical efficacy of PRP for arthroscopic repair of full-thickness rotator cuff tear and investigate the factors that affect its clinical efficacy. Study Design: Systematic review; Level of evidence, 1. Methods: We searched Cochrane Library, EMBASE, MEDLINE, and OVID to identify randomized controlled trials (RCTs) of patients who received PRP treatment and arthroscopic rotator cuff repair (PRP group) versus controls (no-PRP group). The primary outcomes included retear rate, Constant-Murley score, University of California Los Angeles (UCLA) score, short-term American Shoulder and Elbow Surgeons (ASES) score, visual analog scale (VAS) score for pain, and adverse events. Results: A total of 14 RCTs were included in this systematic review. Significant improvement in Constant-Murley, UCLA, and VAS pain scores were found in the PRP group during short-term, midterm, and long-term follow-up. The PRP group had a significantly decreased retear rate (risk ratio [RR], 0.57 [95% CI, 0.42 to 0.78]; P = .0003), especially for long-term follow-up (RR, 0.38 [95% CI, 0.17 to 0.83]; P = .02), large to massive tears (RR, 0.58 [95% CI, 0.42 to 0.80]; P = .0008), use of leukocyte-poor PRP (RR, 0.50 [95% CI, 0.33 to 0.76]; P = .001), and intraoperative application of PRP (RR, 0.57 [95% CI, 0.42 to 0.79]; P = .0007). No significant difference between the 2 groups was found in the incidence of adverse events (RR, 1.34 [95% CI, 0.83 to 2.15]; P = .23) or in ASES scores at short-term follow-up (weighted mean difference, 1.04 [95% CI, –3.10 to 5.19]; P = .62). Conclusion: The results of this review indicated that arthroscopic rotator cuff repair with PRP significantly reduced the long-term retear rate and shoulder pain and provided improved long-term shoulder function in patients. Intraoperative application of PRP, use of leukocyte-poor plasma, and large to massive tear size contributed to a significantly decreased retear rate for rotator cuff repair combined with PRP.

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“…We would like to applaud the effort that Snow, Hussain, Pagkalos, Kowalski, Green, Massoud, and James made in their study "The Effect of Delayed Injection of Leukocyte-Rich Platelet Rich Plasma Following Rotator Cuff Repair on Patient Function: A Randomized Double-Blind Controlled Trial." 3 On the assumption that the half-life of circulating platelets is roughly 7 days and that surgery itself will release a considerable number of growth factors, PRP was injected 10 to 14 days postsurgery to provide a potential secondary peak in growth factors.…”

mentioning

confidence: 99%

Editorial Commentary: Platelet-Rich Plasma in the Treatment of Rotator Cuff Tears—From Hero to Zero?

Gwinner

Scheibel

2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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As failure rates after arthroscopic rotator cuff remain high, platelet-rich plasma (PRP) has gained interest as a potential biological augmentation to enhance boneetendon healing. Recent research shows that delayed PRP application fails to significantly improve clinical results or decrease retear rates but may result in less fatty-infiltration of the repaired rotator cuff muscles. In combination with a lower trend toward retear, this may hint that we should not bid farewell to PRP in rotator cuff repair just yet, and whether our current enthusiasm for emerging biological strategies in rotator cuff repair is justified remains subject to additional investigation.

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The Effect of Delayed Injection of Leukocyte-Rich Platelet-Rich Plasma Following Rotator Cuff Repair on Patient Function: A Randomized Double-Blind Controlled Trial

Cited by 33 publications

References 46 publications

The Effect of Platelet-Rich Plasma Leukocyte Concentration on Arthroscopic Rotator Cuff Repair: A Network Meta-analysis of Randomized Controlled Trials

The Effect of Platelet-Rich Plasma Leukocyte Concentration on Arthroscopic Rotator Cuff Repair: A Network Meta-analysis of Randomized Controlled Trials

Application of Platelet-Rich Plasma in Arthroscopic Rotator Cuff Repair: A Systematic Review and Meta-analysis

Editorial Commentary: Platelet-Rich Plasma in the Treatment of Rotator Cuff Tears—From Hero to Zero?

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