Can PRP Produce Better Outcomes for Patients with Rotator Cuff Repair?

Rotator cuff injury affects more than 60% of patients over the age of 80. In the United States alone, orthopedic surgeons perform approximately 250,000 rotator cuff repair surgeries each year.

Since retear rates remain relatively high - from 10% to 91% - platelet-rich therapies (PRTs) are being studied to see if they improve clinical outcomes.

In this article, we'll review a meta-analysis of randomized clinical trials (RCTs) using PRTs for arthroscopic rotator cuff repair.

The Controversy of PRT Use for Rotator Cuff Repair

PRTs can be divided into platelet-rich plasma (PRP) and platelet-rich fibrin (PRF). Each can be further categorized into leukocyte-rich and leukocyte-poor versions.

Several previous reviews and meta-analyses have found that PRP can provide the following clinical benefits:

• Reduced retear rate
• Lower pain level
• Improvements in function

However, PRF has only been shown to improve function.

Despite these studies showing clinical benefits, the controversy over the use of PRTs for rotator cuff repairs remains.

Those against their use cite studies in which PRTs had no significant benefits. Others have said that PRPs may improve clinical outcomes but that they could not recommend their use due to too much variability in preparations.

Meta-Analysis Shows PRP Improves Clinical Outcomes of Rotator Cuff Repair

The present review provides an updated evaluation on the effects of PRP and PRF on the outcomes of rotator cuff repair surgery.

Studies were included if they were:

• Randomized, clinical trials (RCTs) or quasi-RCTs comparing the effects of PRP, PRF, mesenchymal stem cells, or growth factors to a control group
• Published in a peer-reviewed journal
• Published in English
• Published with full text available

Studies were excluded if they were:

• Non-randomized
• Retrospective
• Reviews
• Basic science
• Incomplete

A study was also excluded if it was the only study under a particular theme.

After removing duplicates, the researchers had 23 studies with 1,440 patients for this review. Sixteen trials compared 498 patients treated with PRP to 504 patients treated with a control. Seven trials compared 221 patients with PRF treatment to 227 with control. All studies included were level I or II RCTs, with an average follow-up period of 17.6 months.

The investigators performed statistical analysis of the following results:

• Retear rate of all sizes
• Constant score
• University of California, Los Angeles score
• American Shoulder and Elbow Surgeons score
• Visual analog scale score
• Disabilities of the Arm, Shoulder, and Hand questionnaire score
• Oxford Shoulder Score
• Simple Shoulder Test score
• Range of motion (ROM)

PRP Reduces Rotator Cuff Retear Rate and Pain Level

Previous analyses couldn't find a difference between patients treated with PRF and those treated with a control. However, the present study did find a slight difference in the functional outcome with PRF. While the difference was not clinically significant, it showed that PRF may have potential for further study.

The reviewers found that patients treated with PRP had reduced retear rate, lower pain level, and improved function. In particular, the treatment with PRP was shown to prevent tendon retear long-term (≥24 months).

A Safe, Effective Addition to Rotator Cuff Repair

This study adds to the growing body of evidence that PRP is a safe and effective addition to rotator cuff repair.

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