Sunday, October 18, 2015

Rotator cuff repair - effect of platelet rich plasma

Efficacy of platelet-rich plasma in arthroscopic repair of full-thickness rotator cuff tears: a meta-analysis.

These authors used a systematic review to compare the clinical improvement and tendon-to-bone healing with and without platelet-rich plasma (PRP)* therapy in arthroscopic rotator cuff repair. They reviewed clinical scores such as the Constant score, the American Shoulder and Elbow Surgeons score, the University of California at Los Angeles (UCLA) Shoulder Rating Scale, the Simple Shoulder Test, and the failure-to-heal rate by magnetic resonance imaging between PRP+ and PRP- groups. The five included studies were randomized controlled trials with a high level of methodologic quality in which 303 patients were enrolled.

Their analysis of the five Level I studies found no statistically significant differences between PRP+ and PRP- groups for overall outcome scores (P > .05). However, the PRP+ group exhibited better healing rates postoperatively than the PRP- group (P = .03) in small/moderate full-thickness tears  but there was no difference in severe-to-massive tears.

* a sample of autologous blood with concentrations of platelets above baseline values

Comment: There continues to be major interest in the use of platelet-rich plasma to augment the healing of soft tissue repairs. This is a carefully done study of five high-quality randomized trials. As we've seen before, the results suggest that cuff integrity after repair does not correlate well with the clinical course after attempted cuff repair.

The manuscript does not present data on the incremental cost of PRP treatment.


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