To assess the effect of platelet rich plasma augmentation on the clinical outcomes and postoperative healing as measured by magnetic resonance imaging of arthroscopic rotator cuff repairs. Introduction: The incidence of tendon rerupture following rotator cuff repair varies depending upon the patient's age, number of tendons involved, and tear size. Reported retear rates of 80% to 90% exist in the radiology literature and up to 57% in the orthopedic literature. Platelet rich plasma (PRP) has emerged as a new technology believed to stimulate revascularization of soft tissue and increase the concentration of growth factors to improve and accelerate tendon healing. PRP is being used to augment soft tissue reconstructions including arthroscopic rotator cuff repairs. Our hypothesis was that the addition of PRP would result in improved healing of arthroscopic rotator cuff repairs.
A prospective series of patients undergoing arthroscopic rotator cuff repair was studied. Patients were randomized into PRP and non-PRP groups. All patients had diagnosed rotator cuff tears from both physical examination and preoperative MRI. A single row rotator cuff repair was performed by same surgeon. At the end of the repair, half of the patients had a preformed platelet rich plasma globule sutured into the repair site. Postoperative rehabilitation was held constant. Postoperative MRIs were obtained at as early as 3 months after surgery to evaluate the presence of rotator cuff defects, their size, muscular fatty atrophy, and any tendon retraction. Additional outcome measures used included the ASES, Rowe, SANE, Simple Shoulder Test, and Constant score.
34 patients (9 females, 25 males) with average age 57 years (range, 43-69) were enrolled in the study. Average follow up was 15.6 months (range, 6-32). All underwent postoperative MRIs at an average of 4.5 months (range, 3-10) after surgery. A total of 17 patients (Groups 1) had platelet rich plasma sutured at the repair site. 59% (10 of 17) had persistent tendon defects on MRI. Group 2 included 17 patients without a PRP sutured globule sutured into the tendon repair site (control group). 94% (16 of 17) of Group 2 demonstrated a persistent tendon defect on MRI (p< 0.01). There was no significant difference between Groups (1 and 2) for ASES (95.7 and 90.0; p=0.13), Rowe (94.5 and 88.5; p=0.09), SANE (91.1 and 87.7; p=0.51), Simple Shoulder Test (11.3 and 10.9; p=0.36), and Constant (89.4 and 83.5; p=0.16) scores.
Patients whose arthroscopic cuff repairs included a PRP globule demonstrated fewer retears (56%) than cuff repairs without PRP globules (94%). However, there was no clinical difference using standard outcome measures.
© 2010 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.