Does platelet rich plasma significantly improve patient outcomes for rotator cuff repair?

The clinical efficacy of leukocyte-poor platelet-rich plasma in arthroscopic rotator cuff repair: a meta-analysis of randomized controlled trials

These authors performed a meta-analysis of 10 randomized controlled trials (RCTs) involving 742 patients to evaluate whether leucocyte-poor PRP significantly affects the outcomes of arthroscopic rotator cuff repair.

The meta-analysis showed that in comparison to controls, treatment with leukocyte-poor PRP was associated with 

(1) statistically significantly less postoperative pain than the control in the short-term and long-term, however, the changes in

the VAS were below the MCID. 

(2) statistically significantly higher patient reported outcomes, however, the changes in the Constant and UCLA scores were below the MCID.

(3) statistically lower rates of retears 

The authors concluded that "leukocyte-poor PRP is associated with lower retear rates in the medium and long term regardless of the tear size and methods used for rotator cuff repair. However, the use of leukocyte-poor PRP in terms of postoperative pain and patient reported outcomes failed to show clinically meaningful effects."

Comment: We should consider how to best assess the value (benefit to the patient/cost) of leukocyte-poor PRP. 

This quote from a PRP vendor (see this link) is of interest:

"We make no bones about promoting platelet-rich plasma (PRP) therapy as a way of increasing revenues and expanding a medical practice. Both PRP and stem cell therapies are gaining wider acceptance along with a growing body of evidence proving their effectiveness. But there is an elephant in the room that, unfortunately, is hindering the growth of PRP therapy in this country. That elephant is disguised as America’s insurance companies.

It is no secret that health insurance providers are not convinced of the efficacy or usefulness of PRP therapy. That, despite growing demand for PRP therapy training among doctors looking to meet increasing demand among patients. It is also no secret that the vast majority of patients who inquire about PRP therapy never go through with it after they find out they have to pay out of pocket."

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