Friday, December 13, 2013

Cuff repair with autologous leukocyte- and platelet-rich fibrin

Increased vascularization during early healing afterbiologic augmentation in repair of chronic rotator cufftears using autologous leukocyte- and platelet-rich fibrin (L-PRF): a prospective randomized controlled pilot trial

The authors note that failure rates of open and arthroscopic single-row and double-row repairs are still high despite constant developments in surgical techniques and suture materials. They hypothesized that arthroscopic rotator cuff repairs using leukocyte- and platelet-rich fibrin (L-PRF) would lead to superior results in cuff repair using a double-row tension band technique. 

There were no significant differences in the subjective shoulder value, visual analog scale, Constant, and Simple Shoulder Test scores at 6 and 12 weeks.

The mean vascularization index of the surgical tendon-to-bone insertions was significantly higher in the L-PRF group than in the contralateral healthy shoulders at 6 and 12 weeks (P .0001). 

The L-PRF group showed a higher vascularization compared with the control group at 6 weeks (P .001), but no difference after 12 weeks of follow-up (P . .889). 

Only 8 of the 10 shoulders in the L-PRF. group and 6 of the 10 in the control group had healed completely at the 3-month follow-up. The relationship of healing to clinical outcome was not presented.

This is a commendable randomized study. The authors point out that the use of autologous platelet-derived growth factors results in longer surgical time, is more expensive, and may be technically more demanding.

Comment: This approach attempts to augment the healing response by application of leukocyte and platelet-rich thrombin, naturally occurring factors that may be washed away by arthroscopic irrigation. In an open rotator cuff repair, the tendon is place in a bleeding bony grove that may well contain these same healing factors.


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