Advertisement

Transosseous-Equivalent/Suture Bridge Technique in Combination with Platelet-Rich Product Application Yield Optimal Clinical Outcomes in Arthroscopic Rotator Cuff Repair: A Bayesian Network Analysis of Randomized Controlled Trials

  • Minchao Lv
    Affiliations
    Department of Orthopedics, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital. No.100, Minjiang Avenue, Quzhou, Zhejiang Province, China
    Search for articles by this author
  • Qingxin Xu
    Affiliations
    Clinical and Translational Research Center, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, No. 2699, Eastern Gaoke Road, Shanghai, China
    Search for articles by this author
  • Feixiong He
    Affiliations
    Department of Orthopedics, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital. No.100, Minjiang Avenue, Quzhou, Zhejiang Province, China
    Search for articles by this author
  • Jinku Guo
    Affiliations
    Department of Orthopedics, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital. No.100, Minjiang Avenue, Quzhou, Zhejiang Province, China
    Search for articles by this author
  • Zhenxin Zheng
    Affiliations
    Department of Orthopedics, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital. No.100, Minjiang Avenue, Quzhou, Zhejiang Province, China
    Search for articles by this author
  • Jun Xie
    Affiliations
    Department of Orthopedics, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital. No.100, Minjiang Avenue, Quzhou, Zhejiang Province, China
    Search for articles by this author
  • Wei Wang
    Correspondence
    Co-corresponding authors: Corresponding Authors, Professor Wei Wang, Department of Orthopedics, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital, Tel: (+86) 570 3125072
    Affiliations
    Department of Orthopedics, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital. No.100, Minjiang Avenue, Quzhou, Zhejiang Province, China
    Search for articles by this author
Published:November 04, 2022DOI:https://doi.org/10.1016/j.arthro.2022.10.039

      ABSTRACT

      Purpose

      To assess the clinical evidence defining the optimal combination of arthroscopic suture technique and Platelet-Rich Products (PRP) application for arthroscopic rotator cuff repair (ARCR).

      Methods

      All level of evidence (LOE) I randomized controlled trials (RCT) focusing arthroscopic suture technique and/or PRP application in ARCR were included. The exclusion criteria were: LOE II or worse; Studies with other interventions; Studies reported none of predetermined clinical outcomes; Studies unable to extract any precise data; Studies from the same patient group of included studies. A pair-wise meta-analysis and Bayesian network analysis were performed on each comparison. The intervention options were ranked by Bayesian network analysis.

      Results

      27 studies comprising 1, 947 individuals met the inclusion criteria. The application of transosseous equivalent/suture bridge repair (SB) with PRP (SB+PRP) significantly reduced retear rate (Risk Ratio [RR], 0.29; 95% confidence interval [CI], [0.15, 0.55].) and increased Constant score (Mean Difference, 1.90; 95% CI, [0.14, 3.74].), compared to SB repair. Single-row repair (SR) with PRP usage (SR+PRP) significantly reduced retear rate (RR, 0.27; 95% CI, [0.12, 0.55].) and pain visual analog scale (VAS) (Mean Difference, -0.84; 95% CI [-1.39, -0.46].), increased University of California, Los Angeles (UCLA) shoulder score (Mean Difference, 1.48; 95% CI [0.50, 2.58].) and Constant score (Mean Difference, 4.53; 95% CI [2.65, 6.38].), compared to SR repair. The ranking for outcomes demonstrated SB+PRP resulted in the best retear rate, UCLA shoulder score, with the second-best postoperative pain, Constant score, while SR+PRP resulted in the best postoperative pain, Constant score, with the second-best retear rate and UCLA score.

      Conclusion

      Arthroscopic rotator cuff repair utilizing SB+PRP yields optimal retear rate and UCLA shoulder score, with the second-best postoperative pain and Constant shoulder outcome score, while SR+PRP yields the best in these two parameters.

      Level of Evidence

      Level I, Bayesian network analysis of level I RCT.

      Keywords

      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 access
      One-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 Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References:

        • Yamamoto A.
        • Takagishi K.
        • Osawa T.
        • et al.
        Prevalence and risk factors of a rotator cuff tear in the general population.
        J Shoulder Elbow Surg. 2010; 19: 116-120
        • Fuchs S.
        • Chylarecki C.
        • Langenbrinck A.
        Incidence and symptoms of clinically manifest rotator cuff lesions.
        Int J Sports Med. 1999; 20: 201-205
        • Tashjian R.Z.
        Epidemiology, natural history, and indications for treatment of rotator cuff tears.
        Clin Sports Med. 2012; 31: 589-604
        • Henry P.
        • Wasserstein D.
        • Park S.
        • et al.
        Arthroscopic Repair for Chronic Massive Rotator Cuff Tears: A Systematic Review.
        Arthroscopy. 2015; 31: 2472-2480
        • Yang J.J.
        • Robbins M.
        • Reilly J.
        • Maerz T.
        • Anderson K.
        The Clinical Effect of a Rotator Cuff Retear: A Meta-analysis of Arthroscopic Single-Row and Double-Row Repairs.
        Am J Sports Med. 2017; 45: 733-741
        • Galatz L.M.
        • Ball C.M.
        • Teefey S.A.
        • Middleton W.D.
        • Yamaguchi K.
        The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears.
        J Bone Joint Surg Am. 2004; 86: 219-224
        • Kim J.R.
        • Cho Y.S.
        • Ryu K.J.
        • Kim J.H.
        Clinical and radiographic outcomes after arthroscopic repair of massive rotator cuff tears using a suture bridge technique: assessment of repair integrity on magnetic resonance imaging.
        Am J Sports Med. 2012; 40: 786-793
        • Park J.Y.
        • Siti H.T.
        • Keum J.S.
        • Moon S.G.
        • Oh K.S.
        Does an arthroscopic suture bridge technique maintain repair integrity?: a serial evaluation by ultrasonography.
        Clin Orthop Relat Res. 2010; 468: 1578-1587
        • Franceschi F.
        • Papalia R.
        • Franceschetti E.
        • et al.
        Double-Row Repair Lowers the Retear Risk After Accelerated Rehabilitation.
        The American journal of sports medicine. 2016; 44: 948-956
        • Burks R.T.
        • Crim J.
        • Brown N.
        • Fink B.
        • Greis P.E.
        A Prospective Randomized Clinical Trial Comparing Arthroscopic Single-and Double-Row Rotator Cuff Repair.
        The American Journal of Sports Medicine. 2009; 37: 674-682
        • Gartsman G.M.
        • Drake G.
        • Edwards T.B.
        • et al.
        Ultrasound evaluation of arthroscopic full-thickness supraspinatus rotator cuff repair: single-row versus double-row suture bridge (transosseous equivalent) fixation. Results of a prospective, randomized study.
        J Shoulder Elb Surg. 2013; 22: 1480-1487
        • Imam M.
        • Sallam A.
        • Ernstbrunner L.
        • et al.
        Three-year functional outcome of transosseous-equivalent double-row vs. single-row repair of small and large rotator cuff tears: a double-blinded randomized controlled trial.
        J Shoulder Elb Surg. 2020; 29: 2015-2026
        • Yamakado K.
        A Prospective Randomized Trial Comparing Suture Bridge and Medially Based Single-Row Rotator Cuff Repair in Medium-Sized Supraspinatus Tears.
        Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2019; 35: 2803-2813
        • Kovacevic D.
        • Rodeo S.A.
        Biological augmentation of rotator cuff tendon repair.
        Clin Orthop Relat Res. 2008; 466: 622-633
        • Krampera M.
        • Pizzolo G.
        • Aprili G.
        • Franchini M.
        Mesenchymal stem cells for bone, cartilage, tendon and skeletal muscle repair.
        Bone. 2006; 39: 678-683
        • Nho S.J.
        • Delos D.
        • Yadav H.
        • et al.
        Biomechanical and biologic augmentation for the treatment of massive rotator cuff tears.
        Am J Sports Med. 2010; 38: 619-629
      1. Oh JH, Chung SW, Kim SH, Chung JY, Kim JY. 2013 Neer Award: Effect of the adipose-derived stem cell for the improvement of fatty degeneration and rotator cuff healing in rabbit model. J Shoulder Elbow Surg. 2014;23(4):445-455.

        • Bava E.D.
        • Barber F.A.
        Platelet-rich plasma products in sports medicine.
        Phys Sportsmed. 2011; 39: 94-99
        • Bielecki T.
        • Dohan E.D.
        Platelet-rich plasma (PRP) and Platelet-Rich Fibrin (PRF): surgical adjuvants, preparations for in situ regenerative medicine and tools for tissue engineering.
        Curr Pharm Biotechnol. 2012; 13: 1121-1130
        • Mishra A.
        • Harmon K.
        • Woodall J.
        • Vieira A.
        Sports medicine applications of platelet rich plasma.
        Curr Pharm Biotechnol. 2012; 13: 1185-1195
        • Sheth U.
        • Simunovic N.
        • Klein G.
        • et al.
        Efficacy of autologous platelet-rich plasma use for orthopaedic indications: a meta-analysis.
        J Bone Joint Surg Am. 2012; 94: 298-307
        • Anitua E.
        • Sanchez M.
        • Nurden A.T.
        • et al.
        Autologous fibrin matrices: a potential source of biological mediators that modulate tendon cell activities.
        J Biomed Mater Res A. 2006; 77: 285-293
        • Arnoczky S.P.
        • Delos D.
        • Rodeo S.A.
        What Is Platelet-Rich Plasma?.
        Oper Techn Sport Med. 2011; 19: 142-148
        • Everts P.
        • Onishi K.
        • Jayaram P.
        • Lana J.F.
        • Mautner K.
        Platelet-Rich Plasma: New Performance Understandings and Therapeutic Considerations in 2020.
        Int J Mol Sci. 2020; 21: 7794
        • Ruiz-Moneo P.
        • Molano-Muñoz J.
        • Prieto E.
        • Algorta J.
        Plasma Rich in Growth Factors in Arthroscopic Rotator Cuff Repair: A Randomized, Double-Blind, Controlled Clinical Trial.
        Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2013; 29: 2-9
        • Barber F.A.
        Triple-Loaded Single-Row Versus Suture-Bridge Double-Row Rotator Cuff Tendon Repair With Platelet-Rich Plasma Fibrin Membrane: A Randomized Controlled Trial.
        Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2016; 32: 753-761
        • Castricini R.
        • Longo U.G.
        • De Benedetto M.
        • et al.
        Platelet-Rich Plasma Augmentation for Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial.
        The American journal of sports medicine. 2011; 39: 258-265
        • Jeremy Howick I.C.P.G.
        Explanation of the 2011 Oxford Centre for Evidence-Based Medicine.
        (OCEBM) Levels of Evidence. 2022; : 2011
        • Higgins J.P.
        • Altman D.G.
        • Gotzsche P.C.
        • et al.
        The Cochrane Collaboration's tool for assessing risk of bias in randomised trials.
        BMJ. 2011; 343: d5928
        • Landis J.R.
        • Koch G.G.
        The Measurement of Observer Agreement for Categorical Data.
        Biometrics. 1977; 33: 159
        • Sugaya H.
        • Maeda K.
        • Matsuki K.
        • Moriishi J.
        Functional and structural outcome after arthroscopic full-thickness rotator cuff repair: single-row versus dual-row fixation.
        Arthroscopy. 2005; 21: 1307-1316
        • Wan X.
        • Wang W.
        • Liu J.
        • Tong T.
        Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range.
        Bmc Med Res Methodol. 2014; 14: 135
        • D Ambrosi R.
        • Palumbo F.
        • Paronzini A.
        • Ragone V.
        • Facchini R.M.
        Platelet-rich plasma supplementation in arthroscopic repair of full-thickness rotator cuff tears: a randomized clinical trial.
        MUSCULOSKELETAL SURGERY. 2016; 100: 25-32
        • Carbonel I.
        • Martinez A.A.
        • Calvo A.
        • Ripalda J.
        • Herrera A.
        Single-row versus double-row arthroscopic repair in the treatment of rotator cuff tears: a prospective randomized clinical study.
        Int Orthop. 2012; 36: 1877-1883
        • Ebert J.R.
        • Wang A.
        • Smith A.
        • et al.
        A Midterm Evaluation of Postoperative Platelet-Rich Plasma Injections on Arthroscopic Supraspinatus Repair: A Randomized Controlled Trial.
        The American Journal of Sports Medicine. 2017; 45: 2965-2974
        • Flury M.
        • Rickenbacher D.
        • Schwyzer H.K.
        • et al.
        Does Pure Platelet-Rich Plasma Affect Postoperative Clinical Outcomes After Arthroscopic Rotator Cuff Repair? A Randomized Controlled Trial.
        Am J Sports Med. 2016; 44: 2136-2146
        • Franceschi F.
        • Ruzzini L.
        • Longo U.G.
        • et al.
        Equivalent clinical results of arthroscopic single-row and double-row suture anchor repair for rotator cuff tears: a randomized controlled trial.
        Am J Sports Med. 2007; 35: 1254-1260
        • Gumina S.
        • Campagna V.
        • Ferrazza G.
        • et al.
        Use of Platelet-Leukocyte Membrane in Arthroscopic Repair of Large Rotator Cuff Tears.
        Journal of Bone and Joint Surgery. 2012; 94: 1345-1352
        • Jo C.H.
        • Shin J.S.
        • Lee Y.G.
        • et al.
        Platelet-rich plasma for arthroscopic repair of large to massive rotator cuff tears: a randomized, single-blind, parallel-group trial.
        Am J Sports Med. 2013; 41: 2240-2248
        • Jo C.H.
        • Shin J.S.
        • Shin W.H.
        • Lee S.Y.
        • Yoon K.S.
        • Shin S.
        Platelet-rich plasma for arthroscopic repair of medium to large rotator cuff tears: a randomized controlled trial.
        Am J Sports Med. 2015; 43: 2102-2110
        • Koh K.H.
        • Kang K.C.
        • Lim T.K.
        • Shon M.S.
        • Yoo J.C.
        Prospective Randomized Clinical Trial of Single- Versus Double-Row Suture Anchor Repair in 2- to 4-cm Rotator Cuff Tears: Clinical and Magnetic Resonance Imaging Results.
        Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2011; 27: 453-462
        • Lapner P.L.C.
        • Sabri E.
        • Rakhra K.
        • et al.
        A Multicenter Randomized Controlled Trial Comparing Single-Row with Double-Row Fixation in Arthroscopic Rotator Cuff Repair.
        Journal of Bone and Joint Surgery. 2012; 94: 1249-1257
        • Li M.
        • Wang K.
        • Zhang H.
        • Fang C.
        • Liu H.
        • Zhang Y.
        Clinical Evaluations of Intraoperative Injection of Platelet-Rich Plasma in Arthroscopic Single-Row Rotator Cuff Repair at 2-Year Follow-Up.
        Biomed Res Int. 2021; 2021: 1-9
        • Liu B.
        • Jeong H.J.
        • Yeo J.H.
        • Oh J.H.
        Efficacy of Intraoperative Platelet-Rich Plasma Augmentation and Postoperative Platelet-Rich Plasma Booster Injection for Rotator Cuff Healing: A Randomized Controlled Clinical Trial.
        Orthopaedic Journal of Sports Medicine. 2021; 91536772115
        • Malavolta E.A.
        • Gracitelli M.E.
        • Ferreira N.A.
        • Assuncao J.H.
        • Bordalo-Rodrigues M.
        • de Camargo O.P.
        Platelet-rich plasma in rotator cuff repair: a prospective randomized study.
        Am J Sports Med. 2014; 42: 2446-2454
        • Pandey V.
        • Bandi A.
        • Madi S.
        • et al.
        Does application of moderately concentrated platelet-rich plasma improve clinical and structural outcome after arthroscopic repair of medium-sized to large rotator cuff tear? A randomized controlled trial.
        J Shoulder Elb Surg. 2016; 25: 1312-1322
        • Randelli P.
        • Arrigoni P.
        • Ragone V.
        • Aliprandi A.
        • Cabitza P.
        Platelet rich plasma in arthroscopic rotator cuff repair: a prospective RCT study, 2-year follow-up.
        J Shoulder Elb Surg. 2011; 20: 518-528
        • Wade R.
        • Salgar S.
        Clinico-radiological evaluation of retear rate in arthroscopic double row versus single row repair technique in full thickness rotator cuff tear.
        Journal of Orthopaedics. 2017; 14: 313-318
        • Wang A.
        • McCann P.
        • Colliver J.
        • et al.
        Do postoperative platelet-rich plasma injections accelerate early tendon healing and functional recovery after arthroscopic supraspinatus repair? A randomized controlled trial.
        Am J Sports Med. 2015; 43: 1430-1437
        • Zhang Z.
        The effect of platelet-rich plasma on arthroscopic double-row rotator cuff repair A clinical study with 12-month follow-up.
        Acta Orthop Traumato. 2015;
        • Zumstein M.A.
        • Rumian A.
        • Lesbats V.
        • Schaer M.
        • Boileau P.
        Increased vascularization during early healing after biologic augmentation in repair of chronic rotator cuff tears using autologous leukocyte- and platelet-rich fibrin (L-PRF): a prospective randomized controlled pilot trial.
        J Shoulder Elb Surg. 2014; 23: 3-12
        • Sheean A.J.
        • Hartzler R.U.
        • Burkhart S.S.
        Arthroscopic Rotator Cuff Repair in 2019: Linked, Double Row Repair for Achieving Higher Healing Rates and Optimal Clinical Outcomes.
        Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2019; 35: 2749-2755
        • Meier S.W.
        • Meier J.D.
        The Effect of Double-Row Fixation on Initial Repair Strength in Rotator Cuff Repair: A Biomechanical Study.
        Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2006; 22: 1168-1173
        • Meier S.W.
        • Meier J.D.
        The effect of double-row fixation on initial repair strength in rotator cuff repair: a biomechanical study.
        Arthroscopy. 2006; 22: 1168-1173
        • Sugaya H.
        • Maeda K.
        • Matsuki K.
        • Moriishi J.
        Repair integrity and functional outcome after arthroscopic double-row rotator cuff repair. A prospective outcome study.
        J Bone Joint Surg Am. 2007; 89: 953-960
        • Burkhart S.S.
        • Cole B.J.
        Bridging self-reinforcing double-row rotator cuff repair: we really are doing better.
        Arthroscopy. 2010; 26: 677-680
        • Lo I.K.
        • Burkhart S.S.
        Double-row arthroscopic rotator cuff repair: re-establishing the footprint of the rotator cuff.
        Arthroscopy. 2003; 19: 1035-1042
        • Bedeir Y.H.
        • Schumaier A.P.
        • Abu-Sheasha G.
        • Grawe B.M.
        Type 2 retear after arthroscopic single-row, double-row and suture bridge rotator cuff repair: a systematic review.
        Eur J Orthop Surg Traumatol. 2019; 29: 373-382
        • Park Y.B.
        • Park Y.E.
        • Koh K.H.
        • Lim T.K.
        • Shon M.S.
        • Yoo J.C.
        Subscapularis Tendon Repair Using Suture Bridge Technique.
        Arthrosc Tech. 2015; 4: e133-e137
        • Hein J.
        • Reilly J.M.
        • Chae J.
        • Maerz T.
        • Anderson K.
        Retear Rates After Arthroscopic Single-Row, Double-Row, and Suture Bridge Rotator Cuff Repair at a Minimum of 1 Year of Imaging Follow-up: A Systematic Review.
        Arthroscopy. 2015; 31: 2274-2281
        • Galatz L.M.
        • Ball C.M.
        • Teefey S.A.
        • Middleton W.D.
        • Yamaguchi K.
        The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears.
        J Bone Joint Surg Am. 2004; 86: 219-224
        • Malavolta E.A.
        • Gracitelli M.E.
        • Ferreira N.A.
        • Assuncao J.H.
        • Bordalo-Rodrigues M.
        • de Camargo O.P.
        Platelet-rich plasma in rotator cuff repair: a prospective randomized study.
        Am J Sports Med. 2014; 42: 2446-2454
        • Amable P.R.
        • Carias R.B.
        • Teixeira M.V.
        • et al.
        Platelet-rich plasma preparation for regenerative medicine: optimization and quantification of cytokines and growth factors.
        Stem Cell Res Ther. 2013; 4: 67
        • Bennett J.S.
        Structure and function of the platelet integrin alphaIIbbeta3.
        J Clin Invest. 2005; 115: 3363-3369
        • Dale D.C.
        • Boxer L.
        • Liles W.C.
        The phagocytes: neutrophils and monocytes.
        Blood. 2008; 112: 935-945
        • Herr N.
        • Bode C.
        • Duerschmied D.
        The Effects of Serotonin in Immune Cells.
        Front Cardiovasc Med. 2017; 4: 48
        • Kirmani B.H.
        • Jones S.G.
        • Datta S.
        • Mclaughlin E.K.
        • Hoschtitzky A.J.
        A meta-analysis of platelet gel for prevention of sternal wound infections following cardiac surgery.
        Blood Transfus. 2017; 15: 57-65
        • Zirlik A.
        • Maier C.
        • Gerdes N.
        • et al.
        CD40 ligand mediates inflammation independently of CD40 by interaction with Mac-1.
        Circulation. 2007; 115: 1571-1580