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

Hurley, Eoghan T.; Colasanti, Christopher A.; Anil, Utkarsh; Luthringer, Tyler A.; Alaia, Michael J.; Campbell, Kirk A.; Jazrawi, Laith M.; Strauss, Eric J.

doi:10.1177/0363546520975435

Cited by 31 publications

(36 citation statements)

References 47 publications

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“…A 2020 meta-analysis of 13 RCTs compared the effect of arthroscopic rotator cuff repair with either LR-or LP-PRP on rates of retear, healing, and pain scores. 38 LP-PRP reduced rates of retear and/or incomplete tendon healing after fixation for both small and medium to large tears. In addition, patients with this treatment experienced reduced pain, as measured by multiple pain scales.…”

Section: Rotator Cuff Tendinopathymentioning

confidence: 90%

“…However, post hoc analyses showed that LR-PRP did not lead to significant improvements over the control group with respect to any outcome metric. 38 Durability of therapeutic benefit is not well characterized, with some studies showing lower rates of re-tears at 1 year. [39][40][41] Others suggest that improvements in pain and functionality wane after 1 year.…”

Section: Rotator Cuff Tendinopathymentioning

confidence: 99%

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Orthobiologics: Diagnosis and Treatment of Common Tendinopathies

Schaik

Lee

2021

Semin Musculoskelet Radiol

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Orthobiologics, including platelet-rich plasma, prolotherapy, and mesenchymal stem cells, are seeing increasing use in the treatment of osteoarthritis (OA), muscle injury, and tendinopathy. This article reviews the biology and applications of orthobiologics in tendons, muscles, and joints, and focuses on platelet-rich plasma (PRP). Clinical evidence-based literature related to the use of PRP in the treatment of rotator cuff injury, lateral epicondylosis, Achilles tendinopathy, plantar fasciitis, knee OA, and acute muscle injury are discussed.

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Section: Rotator Cuff Tendinopathymentioning

confidence: 90%

Section: Rotator Cuff Tendinopathymentioning

confidence: 99%

Orthobiologics: Diagnosis and Treatment of Common Tendinopathies

Schaik

Lee

2021

Semin Musculoskelet Radiol

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“…However, although LR-PRP appeared to be better than the control, the results were not statistically significant. 14 Furthermore, LR-PRP was not significantly inferior to LP-PRP, and a difference could not be determined. 14 Randelli et al 1 found that PRP made an early impact on tendon healing and pain, but this did not translate to longterm improvements.…”

mentioning

confidence: 92%

“…14 Furthermore, LR-PRP was not significantly inferior to LP-PRP, and a difference could not be determined. 14 Randelli et al 1 found that PRP made an early impact on tendon healing and pain, but this did not translate to longterm improvements. PRP likely is absorbed in the early postoperative healing phase and does not stay in the joint long term; thus its long-term effects are questionable.…”

mentioning

confidence: 92%

“…Furthermore, my group's meta-analysis 12 found no heterogeneity between treatment with LP-PRP and LR-PRP, raising the question, does leukocyte concentration matter for PRP augmentation of rotator cuff repair? Thus, we sought to address this with a network meta-analysis 14 in which we used saline as a common comparator and found that LP-PRP significantly reduced the rate of incomplete tendon healing and retear compared with a control group. However, although LR-PRP appeared to be better than the control, the results were not statistically significant.…”

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confidence: 99%

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Editorial Commentary: Platelet-Rich Plasma for Rotator Cuff Repairs: No Evidence for Improved Long-Term Outcomes … Yet!

Hurley¹

2022

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Platelet-rich plasma (PRP) is an autologous blood product containing a high concentration of platelets, growth factors, and cytokines, which basic science studies have shown may improve tendon healing by promoting angiogenesis, cellular migration, proliferation, and matrix deposition. However, there is still controversy over its clinical efficacy, with randomized controlled trials and subsequent meta-analyses finding mixed results when PRP is used to augment rotator cuff repair. Meta-analyses have found that leukocyte-poor PRP significantly reduces the rate of incomplete tendon healing and retear, but the evidence does not support the use of leukocyte-rich PRP or platelet-rich fibrin matrix compositions. Optimizing PRP use may be as simple as the right PRP preparation or the right concentration of the important cytokines. See related article on page 51F irst, I congratulate authors Randelli, Stoppani, Santarsiero, Nocerino, and Menon on their study, "Platelet-Rich Plasma in Arthroscopic Rotator Cuff Repair: No Differences in Clinical and Radiological Results of a Prospective Randomized Controlled Trial Study at 10-Year Follow-Up." 1 It is an incredible achievement to conduct a randomized controlled trial (RCT) with 10-year follow-up, as it demonstrates long-term commitment to a study. The authors were among the first to conduct an RCT on this topic, in 2011, and will hopefully inspire other authors to follow suit and report their long-term results. 2 The authors found in their initial study that platelet-rich plasma (PRP) reduced postoperative pain in the early months and suggested that PRP positively influenced healing among those with C1 and C2 tears (Boileau et al. 3 classification). 2 At long-term follow-up, however, the authors noted that the minor differences they observed at 2-year follow-up disappeared in the long term, when substantial uniformity in outcomes between the 2 groups was found. 1

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Intra-Articular Platelet-Rich Plasma Injection After Anterior Cruciate Ligament Reconstruction

Ye,

Chen,

Qiao

et al. 2024

JAMA Netw Open

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ImportancePlatelet-rich plasma (PRP) has been considered a promising treatment for musculoskeletal disorders. The effects of PRP on clinical outcomes of anterior cruciate ligament reconstruction (ACLR) are controversial.ObjectiveTo compare subjective outcomes and graft maturity in patients undergoing ACLR with and without postoperative intra-articular PRP injection.Design, Setting, and ParticipantsThis surgeon- and investigator-masked randomized clinical trial included patients treated at a national medical center in China who were aged 16 to 45 years and scheduled to undergo ACLR. Participants were enrolled between March 21, 2021, and August 18, 2022, and followed up for 12 months, with the last participant completing follow-up on August 28, 2023.InterventionsParticipants were randomized 1:1 to the PRP group (n = 60), which received 3 doses of postoperative intra-articular PRP injection at monthly intervals, or to the control group (n = 60), which did not receive postoperative PRP injection. Both groups had the same follow-up schedule.Main Outcomes and MeasuresThe primary outcome was the mean score for 4 subscales of the Knee Injury and Osteoarthritis Outcome Score (KOOS4) (range, 0-100, with higher scores indicating better knee function and fewer symptoms) at 12 months postoperatively. Secondary outcomes were patient-reported outcomes, graft maturity (on magnetic resonance imaging), and physical examinations at 3, 6, and 12 months.ResultsAmong the 120 randomized participants (mean [SD] age, 29.0 [8.0] years; 84 males [70%]), 114 (95%) were available for the primary outcome analysis. The mean KOOS4 scores at 12 months were 78.3 (SD, 12.0; 95% CI, 75.2-81.4) in the PRP group and 76.8 (SD, 11.9; 95% CI, 73.7-79.9) in the control group (adjusted mean between-group difference, 2.0; 95% CI, −2.3 to 6.3; P = .36). Secondary outcomes were not statistically significantly different between the 2 groups except for sports and recreation level and graft maturity at 6 months. Intervention-related adverse events included pain at the injection site and knee swelling after injection.Conclusions and RelevanceIn this randomized clinical trial among patients undergoing ACLR, the addition of postoperative intra-articular PRP injection did not result in superior improvement of knee symptoms and function at 12 months compared with no postoperative injection. Further studies are required to determine appropriate indications for PRP in musculoskeletal disorders.Trial RegistrationChinese Clinical Trial Registry Identifier: ChiCTR2000040262

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

Cited by 31 publications

References 47 publications

Orthobiologics: Diagnosis and Treatment of Common Tendinopathies

Orthobiologics: Diagnosis and Treatment of Common Tendinopathies

Editorial Commentary: Platelet-Rich Plasma for Rotator Cuff Repairs: No Evidence for Improved Long-Term Outcomes … Yet!

Intra-Articular Platelet-Rich Plasma Injection After Anterior Cruciate Ligament Reconstruction

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