Purpose
Despite the theoretic basis and interest in using platelet-rich plasma (PRP) to improve
the potential for rotator cuff healing, there remains ongoing controversy regarding
its clinical efficacy. The objective of this systematic review was to identify and
summarize the available evidence to compare the efficacy of arthroscopic rotator cuff
repair in patients with full-thickness rotator cuff tears who were concomitantly treated
with PRP.
Methods
We searched the Cochrane Central Register of Controlled Trials, Medline, Embase, and
PubMed for eligible studies. Two reviewers selected studies for inclusion, assessed
methodologic quality, and extracted data. Pooled analyses were performed using a random
effects model to arrive at summary estimates of treatment effect with associated 95%
confidence intervals.
Results
Five studies (2 randomized and 3 nonrandomized with comparative control groups) met
the inclusion criteria, with a total of 261 patients. Methodologic quality was uniformly
sound as assessed by the Detsky scale and Newcastle-Ottawa Scale. Quantitative synthesis
of all 5 studies showed that there was no statistically significant difference in
the overall rate of rotator cuff retear between patients treated with PRP and those
treated without PRP (risk ratio, 0.77; 95% confidence interval, 0.48 to 1.23). There
were also no differences in the pooled Constant score; Simple Shoulder Test score;
American Shoulder and Elbow Surgeons score; University of California, Los Angeles
shoulder score; or Single Assessment Numeric Evaluation score.
Conclusions
PRP does not have an effect on overall retear rates or shoulder-specific outcomes
after arthroscopic rotator cuff repair. Additional well-designed randomized trials
are needed to corroborate these findings.
Level of Evidence
Level III, systematic review of Level I, II, and III studies
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ArthroscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Biologic and pharmacologic augmentation of rotator cuff repairs.J Am Acad Orthop Surg. 2011; 19: 583-589
- The demographic and morphological features of rotator cuff disease.J Bone Joint Surg Am. 2006; 88: 1699-1704
- Does the literature confirm superior clinical results in radiographically healed rotator cuffs after rotator cuff repair?.Arthroscopy. 2010; 26: 393-403
- Mechanical strength of repairs of the rotator cuff.J Bone Joint Surg Br. 1994; 76: 371-380
- Does double-row rotator cuff repair improve functional outcome of patients compared with single-row technique?.Am J Sports Med. 2012; 40: 1176-1185
- Does the literature support double-row suture anchor fixation for arthroscopic rotator cuff repair?.Arthroscopy. 2009; 25: 1319-1328
- Arthroscopic revision rotator cuff repair.J Am Acad Orthop Surg. 2011; 19: 657-666
- Growth factors for rotator cuff repair.Clin Sports Med. 2009; 28: 13-23
- Clinical indications and techniques for the use of platelet-rich plasma (PRP) in the shoulder.Oper Tech Sports Med. 2011; 19: 165-169
- Platelet-rich plasma: Current concepts and application in sports medicine.J Am Acad Orthop Surg. 2009; 17: 602-608
- The role of platelet-rich plasma in rotator cuff repair.Sports Med Arthrosc. 2011; 19: 244-250
- Effects of platelet-rich plasma on the quality of repair of mechanically induced core lesions in equine superficial digital flexor tendons: A placebo-controlled experimental study.J Orthop Res. 2010; 28: 211-217
- Can platelet-rich plasma enhance tendon repair?.Am J Sports Med. 2008; 36: 1171-1178
- Temporal growth factor release from platelet-rich plasma, trehalose lyophilized platelets, and bone marrow aspirate and their effect on tendon and ligament gene expression.J Orthop Res. 2009; 27: 1033-1042
- Measuring the whole or the parts?.J Hand Ther. 2001; 14: 128-146
- Measuring disability of the upper extremity: A rationale supporting the use of a regional outcome measure.J Hand Ther. 1999; 12: 269-274
- UCLA anatomic total shoulder arthroplasty.Clin Orthop Relat Res. 1981; : 7-20
- A clinical method of functional assessment of the shoulder.Clin Orthop Relat Res. 1987; : 160-164
- The Penn shoulder score: Reliability and validity.J Orthop Sports Phys Ther. 2006; 36: 138-151
- American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, patient self-report section: Reliability, validity, and responsiveness.J Shoulder Elbow Surg. 2002; 11: 587-594
- Effectiveness evaluation and the shoulder.WB Saunders, Philadelphia2004
- A self-administered questionnaire for assessment of symptoms and function of the shoulder.J Bone Joint Surg Am. 1997; 79: 738-748
- Incorporating variations in the quality of individual randomized trials into meta-analysis.J Clin Epidemiol. 1992; 45: 255-265
- The quality of reporting of randomized trials in the Journal of Bone and Joint Surgery from 1988 through 2000.J Bone Joint Surg Am. 2002; 84: 388-396
- The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses.(Accessed December 30, 2011)
- Quantifying heterogeneity in a meta-analysis.Stat Med. 2002; 21: 1539-1558
- Estimating the mean and variance from the median, range, and the size of a sample.BMC Med Res Methodol. 2005; 5: 13
- Platelet-rich plasma augmentation for arthroscopic rotator cuff repair: A randomized controlled trial.Am J Sports Med. 2011; 39: 258-265
- Platelet rich plasma in arthroscopic rotator cuff repair: A prospective RCT study, 2-year follow-up.J Shoulder Elbow Surg. 2011; 20: 518-528
- Rotator cuff repair healing influenced by platelet-rich plasma construct augmentation.Arthroscopy. 2011; 27: 1029-1035
- Does platelet-rich plasma accelerate recovery after rotator cuff repair?.Am J Sports Med. 2011; 39: 2082-2090
- Effects of platelet-rich fibrin matrix on repair integrity of at-risk rotator cuff tears.Am J Sports Med. 2012; 40: 286-293
- Functional and structural outcome after arthroscopic full-thickness rotator cuff repair: Single-row versus dual-row fixation.Arthroscopy. 2005; 21: 1307-1316
- Platelet-rich plasma augmentation of rotator cuff repair.Am J Sports Med. 2011; 39 (author reply NP9-11 (letter)): NP8-NP9
- Arthroscopic repair of full-thickness rotator cuff tears: Is there tendon healing in patients aged 65 years or older?.Arthroscopy. 2010; 26: 302-309
- Clinical outcome and tendon integrity of arthroscopic versus mini-open supraspinatus tendon repair: A magnetic resonance imaging-controlled matched-pair analysis.Arthroscopy. 2007; 23: 514-521
- Magnetic resonance imaging of arthroscopic supraspinatus tendon repair.J Bone Joint Surg Am. 2007; 89: 1770-1776
Article info
Publication history
Published online: June 14, 2012
Accepted:
March 7,
2012
Received:
February 9,
2012
Footnotes
The authors report that they have no conflicts of interest in the authorship and publication of this article.
Identification
Copyright
© 2012 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
