Impact of Platelet-Rich Plasma on Arthroscopic Repair of Small- to Medium-Sized Rotator Cuff Tears: A Randomized Controlled Trial

Richard Holtby, Monique Christakis, Eran Maman, Joy C MacDermid, Tim Dwyer, George S Athwal, Kenneth Faber, John Theodoropoulos, Linda J Woodhouse, Helen Razmjou, Richard Holtby, Monique Christakis, Eran Maman, Joy C MacDermid, Tim Dwyer, George S Athwal, Kenneth Faber, John Theodoropoulos, Linda J Woodhouse, Helen Razmjou

Abstract

Background: Increased interest in using platelet-rich plasma (PRP) as an augment to rotator cuff repair warrants further investigation, particularly in smaller rotator cuff tears.

Purpose: To examine the effectiveness of PRP application in improving perioperative pain and function and promoting healing at 6 months after arthroscopic repair of small- or medium-sized rotator cuff tears.

Study design: Randomized controlled trial; Level of evidence, 1.

Methods: This was a double-blinded randomized controlled trial of patients undergoing arthroscopic repair of partial- or full-thickness rotator cuff tears of up to 3 cm who were observed for 6 months. Patients were randomized to either repair and PRP application (study group) or repair only (control group) groups. The patient-oriented outcome measures utilized were the visual analog scale (VAS), the Short Western Ontario Rotator Cuff Index (ShortWORC), the American Shoulder and Elbow Surgeons (ASES) form, and the Constant-Murley Score (CMS). Range of motion (ROM) and inflammatory and coagulation markers were measured before and after surgery. Magnetic resonance imaging was used at 6 months to assess retear and fatty infiltration rate.

Results: Eighty-two patients (41 males) with a mean age of 59 ± 8 years were enrolled; 41 patients were included in each group. Both the PRP and control groups showed a significant improvement in their pain level based on the VAS within the first 30 days (P < .0001), with the PRP group reporting less pain than the control group (P = .012), which was clinically significantly different from days 8 through 11. The PRP group reported taking less painkillers (P = .026) than the control group within the first 30 days. All outcome measure scores and ROM improved significantly after surgery (P < .0001), with no between-group differences. No differences were observed between groups in inflammatory or coagulation marker test results (P > .05), retear (14% vs 18% full retear; P = .44), or fatty infiltration rate (P = .08).

Conclusion: The PRP biological augmentation for repair of small- to medium-sized rotator cuff tears has a short-term effect on perioperative pain without any significant impact on patient-oriented outcome measures or structural integrity of the repair compared with control group.

Keywords: healing; platelet-rich plasma; rotator cuff.

Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: This study was funded by a grant from the Physicians Services Incorporated foundation.

Figures

Figure 1.
Figure 1.
Flowchart of participants. FTRCT, full-thickness rotator cuff tear; MRI, magnetic resonance imaging; PRP, platelet-rich plasma.
Figure 2.
Figure 2.
Daily comparison of group visual analog scale (VAS) pain scores (range, 0-10) for the first 30 days. Group differences (PRP vs control) were statistically and clinically significant from days 8 through 11. PRP, platelet-rich plasma.

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