Sunday, November 27, 2011

Rotator cuff tear and platelet rich plasma - what is the evidence?

There is interest in the use of platelet rich plasma to aid in the healing of the rotator cuff to bone.
The way I read the literature, there is little solid evidence to support this treatment adjunct. Here are some of the articles relevant to this topic:

Platelet rich plasma in arthroscopic rotator cuff repair: a prospective RCT study, 2-year follow-up. The follow-up MRI showed no significant difference in the healing rate of the rotator cuff tear.

Does platelet-rich plasma accelerate recovery after rotator cuff repair? A prospective cohort study. The results suggest that PRP application during arthroscopic rotator cuff repair did not clearly demonstrate accelerated recovery clinically or anatomically except for an improvement in internal rotation.

Biologic and pharmacologic augmentation of rotator cuff repairsPlatelet-rich plasma may be a safe adjuvant to rotator cuff repair, but it has not been shown to improve healing or function.

Effects of Platelet-Rich Fibrin Matrix on Repair Integrity of At-Risk Rotator Cuff TearsThe augmentation of at-risk rotator cuff tears with PRFM did not result in improved retear rates or functional outcome scores compared with controls.

Rotator cuff repair healing influenced by platelet-rich plasma construct augmentationThere was no significant difference between groups 1 and 2 in terms of American Shoulder and Elbow Surgeons (94.7 and 95.7, respectively; P = .35), Single Assessment Numeric Evaluation (93.7 and 94.5, respectively; P = .37), Simple Shoulder Test (11.4 and 11.3, respectively; P = .41), and Constant (84.7 and 88.1, respectively; P = .19) scores. The Rowe scores (84.8 and 94.9, respectively; P = .03) were statistically different. The addition of 2 PRPFM constructs sutured into a primary rotator cuff tendon repair resulted in lower retear rates identified on MRI than repairs without the constructs.

The Effect of Platelet-Rich Fibrin Matrix on Rotator Cuff Tendon Healing Platelet-rich fibrin matrix applied to the tendon-bone interface during rotator cuff repair had no effect on tendon healing and tendon vascularity, strength or clinical outcome.

Platelet-rich plasma augmentation for arthroscopic rotator cuff repair All the patients completed follow up at 16 months. There was no statistically significant difference in total Constant score when comparing arthroscopic rotator cuff repair with or without PRP. There was no statistically significant difference in MRI tendon score when comparing arthroscopic rotator cuff repair with or without PRP. Our study does not support the use of autologous PRP for augmentation of a rotator cuff repair to improve the healing of rotator cuff tears

A recent meta-analysis of the use of platelet-rich plasma points to the increasing use of "PRP" in the absence of good evidence supporting its efficacy.


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