Study: Addition of PRP to rotator cuff repair improves structural outcomes of rotator cuff tears

http://www.healio.com/orthopedics/sports-medicine/news/online/%7B2806f22e-3968-4df5-8fd3-580ca10c7677%7D/study-addition-of-prp-to-rotator-cuff-repair-improves-structural-outcomes-of-rotator-cuff-tears

Study: Addition of PRP to rotator cuff repair improves structural outcomes of rotator cuff tears

Jo C. Am J Sports Med. 2013. doi:10.1177/036346513497925.

• October 9, 2013

Patients with large to massive rotator cuff tears who had arthroscopic repair with the addition of platelet-rich plasma had improved structural outcomes compared with patients who underwent arthroscopic repair without platelet-rich plasma, according to results of this study.

"The application of platelet-rich plasma (PRP) for large to massive rotator cuff repairs significantly improved structural outcomes, as evidenced by a decreased retear rate and increased cross-sectional area of the supraspinatus compared with retears without platelet-rich plasma augmentation," the researchers wrote in the study.

Researchers randomized 48 patients into a group who underwent arthroscopic repair of rotator cuff tears and received PRP or a group of patients who underwent arthroscopic repair with no PRP. All patients were between the ages of 45 years and 85 years and had large to massive rotator cuff tears. Patients in the PRP group received three PRP gels applied between the torn end of the rotator cuff and the greater tuberosity. All patients returned to sport at 6 months to 9 months after treatment.

The change in postoperative cross-sectional area of the supraspinatus at 1-year follow-up was –15.54 mm² in the PRP group and –85.62 mm² for patients in the conventional treatment group. Patients who did not receive PRP had a retear rate of 55.6% compared with a 20% retear rate for patients in the PRP group. There were no significant preoperative and postoperative differences in shoulder function scores, pain, range of motion or strength between groups.

Disclosure: The research was supported by the Basic Science Research Program and the Bio & Medical Technology Development Program of the National Research Foundation funded by the Korean government.

http://ajs.sagepub.com/content/41/10/2240.abstract

Platelet-Rich Plasma for Arthroscopic Repair of Large to Massive Rotator Cuff Tears

A Randomized, Single-Blind, Parallel-Group Trial

1. Chris Hyunchul Jo, MD*,†, 
2. Ji Sun Shin, BS†, 
3. Young Gil Lee, MD†,
4. Won Hyoung Shin, MD†, 
5. Hyang Kim, PhD†, 
6. Seung Yeon Lee, MS†,
7. Kang Sup Yoon, MD† and 
8. Sue Shin, MD‡

+Author Affiliations

1. ^†Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
2. ^‡Department of Laboratory Medicine, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
3. Investigation performed at the SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea

1. ↵* Chris Hyunchul Jo, MD, Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-gu, 156-707 Seoul, Korea (e-mail: chrisjo@snu.ac.kr).

Abstract

Background: Platelet-rich plasma (PRP) is expected to have a biological augmentation potential in the healing of various diseases and injuries, including rotator cuff tears. However, few evaluations have been performed specifically for large to massive tears.

Purpose: To assess the efficacy of PRP augmentation in patients undergoing arthroscopic repair for large to massive rotator cuff tears.

Study Design: Randomized controlled trial; Level of evidence, 1.

Methods: A total of 48 patients scheduled for arthroscopic repair of large to massive rotator cuff tears were randomly assigned to receive either PRP-augmented (PRP group) or conventional treatment (conventional group). In the PRP group, 3 PRP gels (3 × 3 mL) were applied to each patient between the torn end and the greater tuberosity. The primary outcome measure was the retear rate assessed by magnetic resonance imaging (MRI) or computed tomographic arthrography (CTA) at a minimum of 9 months after surgery. Secondary outcome measures included pain, range of motion, muscle strength, overall satisfaction, functional scores, and the change in cross-sectional area (CSA) of the supraspinatus.

Results: The retear rate of the PRP group (20.0%) was significantly lower than that of the conventional group (55.6%) (P = .023). Clinical outcomes showed no statistical difference between the 2 groups (all P > .05) except for the overall function (P = .043). The change in 1-year postoperative and immediately postoperative CSA was significantly different between the 2 groups: –15.54 ± 94.34 mm² in the PRP group versus −85.62 ± 103.57 mm² in the conventional group (P = .047).

Conclusion: The application of PRP for large to massive rotator cuff repairs significantly improved structural outcomes, as evidenced by a decreased retear rate and increased CSA of the supraspinatus compared with repairs without PRP augmentation. While there was no significant difference in clinical outcomes except the overall shoulder function after 1-year follow-up, better structural outcomes in the PRP group might suggest improved clinical outcomes at longer term follow-up.

Keywords:

• platelet-rich plasma
 
• large to massive rotator cuff tear
• rotator cuff repair
 
• biological augmentation
 
• retear
 
• integrity

Footnotes

• One or more of the authors has declared the following potential conflict of interest or source of funding: This research was supported by the Basic Science Research Program (No. 2011-0022184) and the Bio & Medical Technology Development Program (No. 2011-0019773) of the National Research Foundation (NRF) funded by the Korean Government (MEST).