Objectives
To determine whether leukocyte-poor platelet-rich plasma (Lp-PRP) reduced retear rates,
reduced fatty infiltration, and improved functional outcomes in patients with degenerative
moderate-to-large rotator cuff tears.
Methods
This was a randomized controlled study at a single center. A consecutive series of
104 patients with moderate-to-large rotator cuff tears was enrolled and randomly allocated
to a control group (double-row suture-bridge arthroscopic rotator cuff repair alone,
n = 52) and a study group (double-row suture-bridge repair followed by 3 Lp-PRP injections
at the tendon repair site during surgery, at days 7 and 14 after surgery, n = 52).
All patients were followed up for 27.2 months (range 24-36 months), with University
of California at Los Angeles (UCLA) shoulder rating scale, the Constant score, and
a visual analog scale (VAS) evaluated respectively. The integrity and fatty infiltration
of repaired tissue were assessed by magnetic resonance imaging using the Sugaya classification
and Goutallier grade classification at 24 months after surgery. Statistical analysis
was performed based on the t test, χ2 test, and the Kendall tau-b correlation coefficient.
Results
Four patients refused follow-up, and 11 patients had incomplete data. Eventually,
a total of 89 patients were available for 24 months follow-up. The mean UCLA score
increased from 14.80 ± 2.53 to 29.37 ± 2.06 in control group and from 13.74 ± 3.30
to 30.14 ± 2.32 in study group (P = .103). The mean Constant score increased from 46.56 ± 5.90 to 86.83 ± 4.94 in control
group and from 44.37 ± 7.92 to 88.80 ± 4.92 in study group (P = .063). The VAS score decreased from 3.22 ± 1.24 to 0.97 ± 1.12 in control group
and in 3.49 ± 1.52 to 1.16 ± 0.99 in study group (P = .41). All differences in UCLA score, Constant score, and VAS between pre- and postoperation
achieved minimal clinically important differences proposed for arthroscopic rotator
cuff repair. Of the 89 patients, 76 had magnetic resonance imaging performed at 24
months after surgery. The retear rate was 17.6% in study group, which was lower than
that in control group (38.1%, P = .049). In addition, the Goutallier grade was found to be significant difference
between groups postoperatively (Kendall tau-b –0.24, P = .03) but no significant difference preoperatively (Kendall tau-b –0.18, P = .11). There were no complications in the patients.
Conclusions
Our procedures involving repeated injections of Lp-PRP during surgery and at days
7 and 14, as described in this study, have positive effects on reducing retear rate
and promoting Goutallier grade in patients following arthroscopic rotator cuff repair
and could also provide substantial clinical outcomes that reach the minimal clinically
important difference for surgical treatment. However, given the numbers available
for analysis, it did not promote better clinical results when compared with the control
group.
Level of Evidence
II, randomized controlled study.
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Article Info
Publication History
Published online: March 02, 2022
Accepted:
February 6,
2022
Received:
September 19,
2021
Footnotes
See commentary on page 2389
The authors report the following potential conflicts of interest or sources of funding: This trial was funded by National Natural Science Foundation of China ( 82002320, 82072398 ) and Natural Science Foundation of Zhejiang Province ( LQ21H060005 ). Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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© 2022 by the Arthroscopy Association of North America
