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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Use of platelet-leukocyte membrane in arthroscopic repair of large rotator cuff tears: a prospective randomized study - JBJS

Use of platelet-leukocyte membrane in arthroscopic repair of large rotator cuff tears: a prospective randomized study (JBJS)

The authors of this study are to be congratulated on a Level I randomized prospective study of the use of a platelet-leukocyte membrane inserted between the cuff and the bone during arthroscopic single row repair of supraspinatus only cuff tears.  It is of interest that for these accomplished Italian surgeons, the use of these membranes added only 11 minutes to the case and added only $90 to the cost of the case. 

The results showed that among the 76 shoulders available for one year followup, retears by MRI were noted only among the 37 shoulders without the membrane (3 retears in total). 

The clinical improvement was substantial and virtually identical in both groups: 24 points in the Constant score and 7 points in the SST. 

The authors are quite modest in their conclusions: "the use of platelet-leukocyte membrane led to a slight improvement, as assessed by MRI, in the repair integrity of large tears involving the supraspinatus tendon, although this improvement was not associated with a better objective functional outcome".

A one year retear rate of 4% is consistent with previous reports of other methods. As the authors point out, the retreat rate may will increase with time; it will be most valuable if they could provide us with a comparison of the two groups at five years.  

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