Does the Use of PRP at the Time of Surgery Improve Clinical Outcomes in RCR When Compared With Control Cohorts?
The incidence of arthroscopic rotator cuff tear repair continues to increase with overall satis- factory results, but retear of the rotator cuff tendon has been reported with appreciable frequency. Technical strides have been made with varying fixation devices and techniques in an attempt to improve on prior reported clinical outcomes and complications from a biomechanical standpoint. However, there is still room for improvement given the need to lower retear rates and improve patient subjective and objective outcomes with the knowledge that recurrent or persistent defects in the rota- tor cuff after repair are common, and important differences in strength and clinical outcomes exist between patients with healed and nonhealed rotator cuff repairs.
Some patient-related factors have been identified as reasons for poor results or tendon failure after rotator cuff repair including increased patient age, larger preoperative size of the cuff tear, impaired patient soft tissue quality, smoking, and systemic disease including diabetes.4 Other extrinsic factors have additionally been attributed as the reason for tendon retear, including overaggressive postoperative rehabilitation. Another proposed cause for the high rate of observed retears is the fibrovascular scar tissue that forms at the tendon-bone interface of repair, which has inferior biomechanical properties in comparison to the native tissue. Biologic augmentation has been suggested in an effort to improve on the strength and quality of this repair tissue, but again studies are limited showing significant improvement with routine use.
Platelet-rich plasma (PRP) or platelet-rich fibrin matrix (PRFM) has recently gained popularity in multiple areas of orthopedic sports medicine either as an isolated nonoperative management option or for concurrent use at the time of surgery for biologic augmentation. There is growing evidence from animal studies that these platelet-derived autologous growth factors may specifically aid in the regeneration of tendon tissue through collagen synthesis, vascularization, and tendon cell proliferation if incorporated at the site of rotator cuff pathology in the setting of operative repair. However, there has been discordance in the results of recent meta-analyses that have explored the efficacy of using PRP at the time of rotator cuff repair because they have been unable to show any overall clinical superiority of its use versus controls.
The overall objective of this review was to conduct a systematic review of these overlapping meta-analyses evaluating the efficacy of PRP use at the time of arthroscopic rotator cuff repair. More specifically, the aims of the study were as follows: (1) to perform a systematic review of meta-analyses evaluating PRP use at the time of arthroscopic rotator cuff repair surgery and to determine its effect on retear rates and clinical outcomes; (2) to provide a framework for the analysis and interpretation of the best currently available evidence; and (3) to identify gaps within the literature where suggestions for continued investigational efforts would be valid. Clinical outcomes include clinical indices (Constant, Simple Shoulder Test, American Shoulder and Elbow Society , University of California e Los Angeles , Single Assessment Numeric Evaluation , and Overall Function Scores), subjective measures (patient Visual Analog Scale score, Constant Pain score), and complications (revision surgery, overall complications) including the retear rates.
Our hypothesis was that PRP would not significantly improve patient outcomes or retear rates in arthroscopic rotator cuff repair when compared with controls.
