Platelet rich plasma in arthroscopic rotator cuff repair: a prospective RCT study, 2-year follow-up. Two-staged application of PRP in arthroscopic rotator cuff repair: a matched-pair analysis Biological Treatment for Osteoarthritis of the Knee: Moving from Bench to Bedside-Current Practical Concepts. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials Platelet-Rich Plasma Augmentation for Arthroscopic Rotator Cuff Repair Platelet-Rich Plasma for Arthroscopic Repair of Large to Massive Rotator Cuff Tears Platelet-Rich Plasma for Arthroscopic Repair of Medium to Large Rotator Cuff Tears Impact of Platelet-Rich Plasma on Arthroscopic Repair of Small- to Medium-Sized Rotator Cuff Tears Does Platelet-Rich Plasma Accelerate Recovery After Rotator Cuff Repair? A Prospective Cohort Study Does Pure Platelet-Rich Plasma Affect Postoperative Clinical Outcomes After Arthroscopic Rotator Cuff Repair? Does application of moderately concentrated platelet-rich plasma improve clinical and structural outcome after arthroscopic repair of medium-sized to large rotator cuff tear? A randomized controlled trial. A Midterm Evaluation of Postoperative Platelet-Rich Plasma Injections on Arthroscopic Supraspinatus Repair: A Randomized Controlled Trial Use of platelet-leukocyte membrane in arthroscopic repair of large rotator cuff tears: a prospective randomized study. Methodological index for non‐randomized studies (MINORS): development and validation of a new instrument Does autologous leukocyte-platelet-rich plasma improve tendon healing in arthroscopic repair of large or massive rotator cuff tears? Platelet-Rich Plasma in Rotator Cuff Repair Platelet-rich plasma supplementation in arthroscopic repair of full-thickness rotator cuff tears: a randomized clinical trial Rotator cuff repair healing influenced by platelet-rich plasma construct augmentation.
HYPOTHESIS Local application of autologous platelet rich plasma ( PRP ) improves tendon healing in patients undergoing arthroscopic rotator cuff repair . STUDY DESIGN Prospect i ve , r and omized , controlled , double blind study ; considering an alpha level of 5 % , a power of 80 % , 22 patients for group are needed . MATERIAL S AND METHODS Fifty-three patients who underwent shoulder arthroscopy for the repair of a complete rotator cuff tear were r and omly divided into 2 groups , using a block r and omization procedure . A treatment group ( N = 26 ) consisted of those who received an intraoperative application of PRP in combination with an autologous thrombin component . A control group ( N = 27 ) consisted of those who did not receive that treatment . Patients were evaluated with vali date d outcome scores . A magnetic resonance image ( MRI ) was performed in all cases at more than 1 year post-op . All patients had the same accelerated rehabilitation protocol . RESULTS The 2 groups were homogeneous . The pain score in the treatment group was lower than the control group at 3 , 7 , 14 , and 30 days after surgery ( P < .05 ) . On the Simple Shoulder Test ( SST ) , University of California ( UCLA ) , and Constant scores , strength in external rotation , as measured by a dynamometer , were significantly higher in the treatment group than the control group at 3 months after surgery ( strength in external rotation [ SER ] : 3 ± 1.6 vs 2.1 ± 1.3 kg ; SST : 8.9 ± 2.2 vs 7.1 ± 2.7 ; UCLA : 26.9 ± 3 vs 24.2 ± 4.9 ; Constant : 65 ± 9 vs 57.8 ± 11 ; P < .05 ) . There was no difference between the 2 groups after 6 , 12 , and 24 months . The follow-up MRI showed no significant difference in the healing rate of the rotator cuff tear . In the subgroup of grade 1 and 2 tears , with less retraction , SER in the PRP group was significant higher at 3 , 6 , 12 , and 24 months postoperative ( P < .05 ) . CONCLUSION The results of our study showed autologous PRP  reduced pain in the first postoperative months . The long-term results of subgroups of grade 1 and 2 tears suggest that PRP positively affected cuff rotator healing Introduction Failure rates after arthroscopic rotator cuff repair remain high . Platelet-rich plasma has gained interest as a potential biological augmentation to enhance bone – tendon healing . The purpose of this study is to evaluate the clinical and structural outcomes of repeated PRP application on rotator cuff repair . Material s and methods Thirty-six patients underwent arthroscopic reconstruction , using knotless anchor double-row repair . Eighteen patients [ 10 female , 8 male ; 61.2 ( ±9.2 ) years ] received two applications of PRP — directly subsequent to the repair and 7 days postoperatively . Eighteen patients [ 11 male , 7 female ; 61.4 ( ±6.5 ) years ] who solely received the same technique of rotator cuff repair were matched for age .  The subjective shoulder value , WORC , and the Constant – Murley score were used for clinical evaluation . MRI was performed for tendon integrity , and cuff appearances were grade d according to the Sugaya classification . Results We prospect ively evaluated the PRP group with a minimum follow-up of 24 months . Clinical results did not show significantly differences in comparison to patients with isolated rotator cuff repair  concerning CS ( 79 ± 13 vs. 77 ± 13 ; P = 0.6 ) , SSV ( 90 ± 14 vs. 88 ± 16 ; P = 0.5 ) or WORC Score ( 90 ± 18 vs. 86 ± 20 ; P = 0.2 ) . At the final follow-up , MRI showed retears in 11 % of the PRP and in 28 % of the control group ( P = 0.4 ) . Conclusions Knotless-anchor double-row repair shows good to excellent clinical results with an acceptable retear rate . Additional two-staged PRP application failed to significantly improve clinical parameters . Even though there was a trend for lower retear rates in the PRP group , it did not achieve statistical difference . Level of evidence Level III , Retrospective comparative study Biological-based therapies for cartilage pathology have gained considerable recognition in the last few decades due to their potential benefits including their minimal invasiveness , capacity for unprecedented healing , and potential for rapid recovery . Consequently , these therapies are likely to have the most noteworthy impact on patients with degenerative joint changes who want to remain active . Currently , the most research ed treatments include platelet-rich plasma ( PRP ) , bone marrow aspirate concentrate ( BMAC ) , and cell-based therapies . Although further basic science research and well- design ed r and omized clinical trials are needed to eluci date the long-term role of these therapies in the treatment of osteoarthritis , there is compelling evidence for their use for certain indications . This article aims to review the existing literature for biological-based treatment options for osteoarthritis , critically assessing the current evidence -based recommendations and identify potential avenues for development Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Background : After reinsertion on the humerus , the rotator cuff has limited ability to heal . Growth factor augmentation has been proposed to enhance healing in such procedure . Purpose : This study was conducted to assess the efficacy and safety of growth factor augmentation during rotator cuff repair . Study Design : R and omized controlled trial ; Level of evidence , 1 . Methods : Eighty-eight patients with a rotator cuff tear were r and omly assigned by a computer-generated sequence to receive arthroscopic rotator cuff repair without ( n = 45 ) or with ( n = 43 ) augmentation with autologous platelet-rich fibrin matrix ( PRFM ) . The primary end point was the postoperative difference in the Constant score between the 2 groups . The secondary end point was the integrity of the repaired rotator cuff , as evaluated by magnetic resonance imaging . Analysis was on an intention-to-treat basis . Results : All the patients completed follow-up at 16 months . There was no statistically significant difference in total Constant score when comparing the results of arthroscopic repair of the 2 groups ( 95 % confidence interval , −3.43 to 3.9 ) ( P = .44 ) . There was no statistically significant difference in magnetic resonance imaging tendon score when comparing arthroscopic repair with or without PRFM ( P = .07 ) . Conclusion : Our study does not support the use of autologous PRFM for augmentation of a double-row repair of a small or medium rotator cuff tear to improve the healing of the rotator cuff . Our results are applicable to small and medium rotator cuff tears ; it is possible that PRFM may be beneficial for large and massive rotator cuff tears . Also , given the heterogeneity of PRFM preparation products available on the market , it is possible that other preparations may be more effective 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 : R and omized controlled trial ; Level of evidence , 1 . Methods : A total of 48 patients scheduled for arthroscopic repair of large to massive rotator cuff tears were r and omly 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 evidence d 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 Background : Two main questions about the use of platelet-rich plasma ( PRP ) for regeneration purpose s are its effect on the speed of healing and the quality of healing . Despite recent numerous studies , evidence is still lacking in this area , especially in a representative patient population with medium to large rotator cuff tears . Purpose : To assess the efficacy of PRP augmentation on the speed and quality of healing in patients undergoing arthroscopic repair for medium to large rotator cuff tears . Study Design : R and omized controlled trial ; Level of evidence , 1 . Methods : A total of 74 patients scheduled for arthroscopic repair of medium to large rotator cuff tears were r and omly assigned to undergo either PRP-augmented repair ( PRP group ) or conventional repair ( 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 was the Constant score at 3 months after surgery . Secondary outcome measures included the visual analog scale ( VAS ) for pain , range of motion ( ROM ) , muscle strength , overall satisfaction and function , functional scores , retear rate , and change in the cross-sectional area ( CSA ) of the supraspinatus muscle . Results : There was no difference between the 2 groups in the Constant score at 3 months ( P > .05 ) . The 2 groups had similar results on the VAS for pain , ROM , muscle strength , overall satisfaction and function , and other functional scores ( all P > .05 ) except for the VAS for worst pain ( P = .043 ) . The retear rate of the PRP group ( 3.0 % ) was significantly lower than that of the conventional group ( 20.0 % ) ( P = .032 ) . The change in 1-year postoperative and immediately postoperative CSAs was significantly different between the 2 groups : –36.76 ± 45.31 mm2 in the PRP group versus −67.47 ± 47.26 mm2 in the conventional group ( P = .014 ) . Conclusion : Compared with repairs without PRP augmentation , the current PRP preparation and application methods for medium to large rotator cuff repairs significantly improved the quality , as evidence d by a decreased retear rate and increased CSA of the supraspinatus , but not the speed of healing . However , further studies may be needed to investigate the effects of PRP on the speed of healing without risking the quality Background : Increased interest in using platelet-rich plasma ( PRP ) as an augment to rotator cuff repair warrants further investigation , particularly in smaller rotator cuff tears . Purpose : To examine the effectiveness of PRP application in improving perioperative pain and function and promoting healing at 6 months after arthroscopic repair of small- or medium-sized rotator cuff tears . Study Design : R and omized controlled trial ; Level of evidence , 1 . Methods : This was a double-blinded r and omized controlled trial of patients undergoing arthroscopic repair of partial- or full-thickness rotator cuff tears of up to 3 cm who were observed for 6 months . Patients were r and omized to either repair and PRP application ( study group ) or repair only ( control group ) groups . The patient-oriented outcome measures utilized were the visual analog scale ( VAS ) , the Short Western Ontario Rotator Cuff Index ( ShortWORC ) , the American Shoulder and Elbow Surgeons ( ASES ) form , and the Constant-Murley Score ( CMS ) . Range of motion ( ROM ) and inflammatory and coagulation markers were measured before and after surgery . Magnetic resonance imaging was used at 6 months to assess retear and fatty infiltration rate . Results : Eighty-two patients ( 41 males ) with a mean age of 59 ± 8 years were enrolled ; 41 patients were included in each group . Both the PRP and control groups showed a significant improvement in their pain level based on the VAS within the first 30 days ( P < .0001 ) , with the PRP group reporting less pain than the control group ( P = .012 ) , which was clinical ly significantly different from days 8 through 11 . The PRP group reported taking less painkillers ( P = .026 ) than the control group within the first 30 days . All outcome measure scores and ROM improved significantly after surgery ( P < .0001 ) , with no between-group differences . No differences were observed between groups in inflammatory or coagulation marker test results ( P > .05 ) , retear ( 14 % vs 18 % full retear ; P = .44 ) , or fatty infiltration rate ( P = .08 ) . Conclusion : The PRP biological augmentation for repair of small- to medium-sized rotator cuff tears has a short-term effect on perioperative pain without any significant impact on patient-oriented outcome measures or structural integrity of the repair compared with control group Background : Platelet-rich plasma ( PRP ) has been recently used to enhance and accelerate the healing of musculoskeletal injuries and diseases , but evidence is still lacking , especially on its effects after rotator cuff repair . Hypothesis : Platelet-rich plasma accelerates recovery after arthroscopic rotator cuff repair in pain relief , functional outcome , overall satisfaction , and enhanced structural integrity of repaired tendon . Study Design : Cohort study ; Level of evidence , 2 . Methods : Forty-two patients with full-thickness rotator cuff tears were included . Patients were informed about the use of PRP before surgery and decided themselves whether to have PRP placed at the time of surgery . Nineteen patients underwent arthroscopic rotator cuff repair with PRP and 23 without . Platelet-rich plasma was prepared via plateletpheresis and applied in the form of a gel threaded to a suture and placed at the interface between tendon and bone . Outcomes were assessed preoperatively and at 3 , 6 , 12 , and finally at a minimum of 16 months after surgery ( at an average of 19.7 ± 1.9 months ) with respect to pain , range of motion , strength , and overall satisfaction , and with respect to functional scores as determined using the following scoring systems : the American Shoulder and Elbow Surgeon ( ASES ) system , the Constant system , the University of California at Los Angeles ( UCLA ) system , the Disabilities of the Arm , Shoulder and H and ( DASH ) system , the Simple Shoulder Test ( SST ) system , and the Shoulder Pain and Disability Index ( SPADI ) system . At a minimum of 9 months after surgery , repaired tendon structural integrities were assessed by magnetic resonance imaging . Results : Platelet-rich plasma gel application to arthroscopic rotator cuff repairs did not accelerate recovery with respect to pain , range of motion , strength , functional scores , or overall satisfaction as compared with conventional repair at any time point . Whereas magnetic resonance imaging demonstrated a retear rate of 26.7 % in the PRP group and 41.2 % in the conventional group , there was no statistical significance between the groups ( P = .388 ) . Conclusion : The results suggest that PRP application during arthroscopic rotator cuff repair did not clearly demonstrate accelerated recovery clinical ly or anatomically except for an improvement in internal rotation . Nevertheless , as the study may have been underpowered to detect clinical ly important differences in the structural integrity , additional investigations , including the optimization of PRP preparation and a larger r and omized study powered for healing rate , are necessary to further determine the effect of PRP Background : The exact role of platelet-rich plasma ( PRP ) in rotator cuff tendon reconstruction remains unclear . Purpose /Hypothesis : This study investigated whether an intraoperative pure PRP injection , compared with a local anesthetic injection , improves patient-reported outcomes at 3 and 6 months after arthroscopic rotator cuff repair . The hypothesis was that pure PRP improves patient-reported outcomes ( Oxford Shoulder Score [ OSS ] ) at 3 and 6 months after surgery and has the same pain-reducing effect compared with a postoperative subacromial local anesthetic ( ropivacaine ) injection . Study Design : R and omized controlled trial ; Level of evidence , 1 . Methods : Between January 2011 and November 2012 , a total of 120 patients who underwent arthroscopic double-row repair of a supraspinatus tendon rupture were r and omized to receive either pure PRP by an injection at the footprint ( PRP group ; n = 60 ) or ropivacaine injected in the subacromial region ( control group ; n = 60 ) . Seventy-eight percent of patients had other concomitant tears . All patients , surgeons , and follow-up investigators were blinded . Clinical parameters and various outcome scores ( Constant-Murley shoulder score ; OSS ; patient American Shoulder and Elbow Surgeons score ; quick Disabilities of the Arm , Shoulder and H and score ; EuroQol 5 dimensions ) were documented preoperatively and at 3 , 6 , and 24 months postoperatively . The repair integrity was assessed by magnetic resonance imaging or ultrasound at 24 months . Furthermore , a pain diary was completed within the first 10 postoperative days , and adverse events were recorded . Group outcome differences were analyzed using t tests , Fisher exact tests , and mixed models . Results : The final follow-up rate was 91 % . An associated tear of the subscapularis tendon was diagnosed in 23 % of PRP-treated patients and 36 % of control patients . Three months after surgery , the mean ( ±SD ) OSS was 32.9 ± 8.6 in PRP-treated patients and 30.7 ± 10.0 in control patients ( P = .221 ) . No significant differences were noted for other outcome parameters as well as at 6 and 24 months postoperatively . Smoking was a significant effect modifier . Pain for both groups decreased from postoperative day 1 to 10 without any significant group difference ( P = .864 ) . Six ( 12.2 % ) and 11 ( 20.8 % ) patients were diagnosed with a recurrent supraspinatus tendon defect in the PRP and control groups , respectively ( P = .295 ) . Twenty-two ( 40.7 % ) and 18 ( 30.5 % ) PRP-treated and control patients , respectively , experienced a local adverse event within 24 months ( P = .325 ) . Conclusion : Patients treated with pure PRP showed no significantly improved function at 3 , 6 , and 24 months after arthroscopic repair compared with control patients receiving ropivacaine ; however , a similar pain reduction was documented in both groups . The negative influence of smoking on the effect of pure PRP requires further investigation . Registration : NCT01266226 ( Clinical Trials.gov ) BACKGROUND Platelet-rich plasma ( PRP ) has the potential to improve tendon-bone healing . The evidence is still controversial as to whether PRP application after repair of medium-sized to large cuff tears leads to superior structural and clinical outcome , especially after single-row repair . METHODS In a r and omized study , 102 patients ( PRP group , 52 patients ; control group , 50 patients ) with medium-sized and large degenerative posterosuperior tears were included for arthroscopic repair with a minimum follow-up of 2 years . Patients were evaluated with clinical scores ( visual analog scale score , Constant-Murley score , University of California-Los Angeles score , and American Shoulder and Elbow Surgeons score ) and ultrasound to assess retear and vascularity pattern of the cuff . RESULTS Visual analog scale scores were significantly lower in the PRP group than in controls at 1 month , 3 months , and 6 months but not later . Constant-Murley scores were significantly better in the PRP group compared with controls at 12 and 24 months , whereas University of California-Los Angeles scores were significantly higher in the PRP group at 6 and 12 months ( P < .05 ) . The American Shoulder and Elbow Surgeons score in both groups was comparable at all the times . At 24 months , retear in the PRP group ( n = 2 ; 3.8 % ) was significantly lower than in the control group ( n = 10 ; 20 % ; P = .01 ) . The retear difference was significant only for large tears ( PRP : control group , 1:6 ; P = .03 ) . Doppler ultrasound examination showed significant vascularity in the PRP group repair site at 3 months postoperatively ( P < .05 ) and in peribursal tissue until 12 months . CONCLUSION Application of moderately concentrated PRP improves clinical and structural outcome in large cuff tears . PRP also enhances vascularity around the repair site in the early phase Background : Platelet-rich plasma ( PRP ) has been applied as an adjunct to rotator cuff repair to improve tendon-bone healing and potentially reduce the incidence of subsequent tendon retears . Purpose : To investigate whether the midterm clinical and radiographic outcomes of arthroscopic supraspinatus repair are enhanced after repeated postoperative applications of PRP . Study Design : R and omized controlled trial ; Level of evidence , 1 . Methods : A total of 60 patients ( 30 control ; 30 PRP ) were initially r and omized to receive 2 ultrasound-guided injections of PRP to the tendon repair site at 7 and 14 days after double-row arthroscopic supraspinatus repair or not . A total of 55 patients ( 91.7 % ) underwent a clinical review and magnetic resonance imaging ( MRI ) at a mean of 3.5 years after surgery ( range , 36 - 51 months ) .  Patient-reported outcome measures ( PROMs ) included the Constant score , Quick Disabilities of the Arm , Shoulder and H and ( QuickDASH ) question naire , Oxford Shoulder Score ( OSS ) , and visual analog scale ( VAS ) for pain . Global rating of change ( GRC ) scale and patient satisfaction scores were evaluated . Structural integrity of the surgical repair was assessed via MRI using the Sugaya classification system . Results : At the midterm review , there was no difference between the groups for any of the PROMs . No differences between the groups were demonstrated for the subjective and range of motion subscales of the Constant score , although a significantly higher Constant strength subscale score was observed in the PRP group ( 3.3 points ; 95 % CI , 1.0 - 5.7 ; P = .006 ) . There was no evidence for any group differences in MRI scores or retear rates , with 66.7 % of PRP patients and 64.3 % of control patients rated as Sugaya grade 1 . Two control patients had symptomatic retears ( both full thickness ) within the first 16 weeks after surgery compared with 2 PRP patients , who suffered symptomatic retears ( both partial thickness ) between 16 weeks and a mean 3.5-year follow-up . Conclusion : Significant postoperative clinical improvements and high levels of patient satisfaction were observed in patients at the midterm review after supraspinatus repair . While pain-free , maximal abduction strength was greater in the midterm after PRP treatment , repeated applications of PRP delivered at 7 and 14 days after surgery provided no additional benefit to tendon integrity BACKGROUND Arthroscopic rotator cuff repair  generally provides satisfactory results including decreased shoulder pain and improved shoulder motion . Unfortunately , imaging studies demonstrate that the retear rate associated with the available arthroscopic techniques may be high . The purpose of this study was to evaluate the clinical and magnetic resonance imaging ( MRI ) results of arthroscopic rotator cuff repair with and without the use of platelet-leukocyte membrane in patients with a large posterosuperior rotator cuff tear . METHODS Eighty consecutive patients with a large full-thickness posterosuperior rotator cuff tear were enrolled . All tears were repaired using an arthroscopic single-row technique .  Patients were r and omized to treatment either with or without a platelet-leukocyte membrane inserted between the rotator cuff tendon and its footprint . In patients treated with this membrane , one membrane was utilized for each suture anchor . The primary outcomes were the difference between the preoperative and postoperative Constant scores and the repair integrity assessed by MRI according to the Sugaya classification . The secondary outcome was the difference between the preoperative and postoperative Simple Shoulder Test ( SST ) scores . RESULTS The only significant differences between the two groups involved the patient age and the preoperative and postoperative Constant scores ; the differences in the Constant score were due to differences in the shoulder pain subscore . At a mean of thirteen months of follow-up , rotator cuff retears were observed only in the group of patients in whom the membrane had not been used , and a thin but intact tendon was observed more frequently in this group as well . The use of the membrane was associated with significantly better repair integrity ( p = 0.04 ) . CONCLUSIONS The use of the platelet-leukocyte membrane in the treatment of rotator cuff tears improved repair integrity compared with repair without membrane . However , the improvement in repair integrity was not associated with greater improvement in the functional outcome . In fact , the Constant scores of the two groups would have been similar if the shoulder pain component ( which had differed preoperatively ) had been excluded Background : Because of specific method ological difficulties in conducting r and omized trials , surgical research remains dependent predominantly on observational or non‐r and omized studies . Few vali date d instruments are available to determine the method ological quality of such studies either from the reader 's perspective or for the purpose of meta‐ analysis . The aim of the present study was to develop and vali date such an instrument PURPOSE To evaluate the clinical and magnetic resonance imaging ( MRI ) outcome of arthroscopic rotator cuff repair with the use of leukocyte-platelet-rich plasma ( L-PRP ) in patients with large or massive rotator cuff tears . METHODS A comparative cohort of patients with large or massive rotator cuff tears undergoing arthroscopic repair was studied . Two consecutive groups of patients were included : rotator cuff repairs with L-PRP injection ( group 1 , n = 35 ) and rotator cuff repairs without L-PRP injection ( group 2 , n = 35 ) . A double-row cross-suture cuff repair was performed by a single surgeon with the same rehabilitation protocol . Patients were clinical ly evaluated with the Constant score ; Simple Shoulder Test score ; University of California , Los Angeles ( UCLA ) score ; and strength measurements by use of a h and held dynamometer . Rotator cuff healing was evaluated by postoperative MRI using the Sugaya classification ( type 1 to type 5 ) . RESULTS We prospect ively evaluated the 2 groups at a minimum 2-year follow-up . The results did not show differences in cuff healing between the 2 groups ( P = .16 ) . The size of recurrent tears ( type 4 v type 5 ) , however , was significantly smaller in group 1 ( P = .008 ) . There was no statistically significant difference in the recurrent tear rate ( types 4 and 5 ) between the 2 groups ( P = .65 ) . There was no significant difference between group 1 and group 2 in terms of University of California , Los Angeles score ( 29.1 and 30.3 , respectively ; P = .90 ) ; Simple Shoulder Test score ( 9.9 and 10.2 , respectively ; P = .94 ) ; Constant score ( 77.3 and 78.1 , respectively ; P = .82 ) ; and strength ( 7.5 and 7.0 , respectively ; P = .51 ) . CONCLUSIONS In our study the use of autologous L-PRP did not improve the quality of tendon healing in patients undergoing arthroscopic repair of large or massive rotator cuff tears based on postoperative MRI evaluation . The only significant advantage was that the L-PRP patients had smaller iterative tears . However , the functional outcome was similar in the 2 groups of patients . LEVEL OF EVIDENCE Level III , case-control study Background : Although platelet-rich plasma ( PRP ) has been used in rotator cuff repair , most authors have been unable to report the advantages of this method in clinical trials . Hypothesis : The use of PRP promotes better functional and structural results in arthroscopic rotator cuff repair . Study Design : R and omized controlled trial ; Level of evidence , 1 . Methods : This was a prospect i ve , r and omized , double-blind study with 2 groups of 27 patients each ( PRP group and control group ) . Complete supraspinatus tears with retraction of less than 3 cm were subjected to arthroscopic single-row repair ;  at the end of the surgical procedure , liquid PRP prepared by apheresis was given to the patients in the PRP group with autologous thrombin . The outcomes were assessed by the University of California at Los Angeles ( UCLA ) and Constant scales , visual analog scale ( VAS ) for pain , and magnetic resonance imaging ( MRI ) before and 3 , 6 , 12 , and 24 months after surgery . The significance level was 5 % . Results : The 2 groups of patients exhibited significant clinical improvement ( P < .001 ) . Between the preoperative assessment and 24-month follow-up , the mean UCLA score increased from 13.63 ± 3.639 to 32.70 ± 3.635 and from 13.93 ± 4.649 to 32.44 ± 4.318 in the control and PRP groups , respectively ( P = .916 ) . The mean Constant score increased from 47.37 ± 11.088 to 85.15 ± 9.879 in the control group and from 46.96 ± 11.937 to 84.78 ± 14.048 in the PRP group ( P = .498 ) . The mean VAS score varied from 7.00 ± 1.939 and 6.67 ± 1.617 before surgery to 1.15 ± 1.916 and 0.96 ± 2.244 at the 24-month assessment in the control and PRP groups , respectively ( P = .418 ) . The only difference was in the mean UCLA score at 12 months , with 30.04 ± 4.528 in the control group and 32.30 ± 3.506 in the PRP group ( P = .046 ) . The control group exhibited 1 case of a complete retear and 4 partial retears , and the PRP group exhibited 2 cases of partial retears ( P = .42 ) . Conclusion : Platelet-rich plasma prepared by apheresis and applied in the liquid state with thrombin did not promote better clinical results at 24-month follow-up . Given the numbers available for analysis , the retear rate also did not change Background Results on the effectiveness of PRP supplementation in arthroscopic rotator cuff repair are conflicting , making it difficult to draw definitive conclusions . Methods This was a prospect i ve , r and omized , and double-blind study with two groups of 20 patients each ( PRP group and control group ) . Degenerative supraspinatus full-thickness tears grade C2–C3 were subjected to arthroscopic repair ; PRP supplementation was given to patients in the PRP group . The outcomes were assessed by DASH , Constant scales , and ultrasound before and 6 months after surgery . Pain measured by VAS was evaluated preoperatively and 7 and 30 days after surgery . Results The two groups did not differ significantly by age , sex , and dominance of the affected side . In all surgical procedures , a long head of the biceps tenotomy and single-row repair were performed . The preoperative VAS was 5.6 ± 2.4 in PRP group and 6.4 ± 1.5 in the control group ( p > 0.05 ) . The group supplemented with PRP reported a VAS significantly better in the first week ( 2.5 ± 1.9 vs 5.3 ± 2.1 , p < 0.05 ) and during the first month after surgery ( 1.5 ± 1.0 vs 3.2 ± 1.7 , p < 0.05 ) compared to the control group . The preoperative Constant and DASH scores were 39.95 ± 12 and 51 ± 15.2 , respectively , in the PRP group and 41 ± 11 ( p > 0.05 ) and 45 ± 12.6 ( p > 0.05 ) in the control group . The average Constant score improved significantly after 6 months to 81 ± 11.2 ( p < 0.05 ) in the PRP group and 78.5 ± 9 ( p < 0.05 ) in the control group . No differences were noted between the two groups ( p > 0.05 ) . The DASH score after 6 months was 17.4 ± 8 ( p < 0.05 ) for the treatment group ( the PRP group ) and 21 ± 8.4 ( p < 0.05 ) for the control group . No statistically significant differences were found as regards the DASH score in the two groups after 6 months ( p > 0.05 ) . The two groups showed no differences in the ultrasound evaluation after 6 months either . No re-ruptures occurred in either group . Conclusions PRP leads to a reduction in pain during a short-term follow-up . Pain reduction allows for a more rapid recovery of mobilization and improvement in functionality . Level of evidence R and omized controlled trial , Level of evidence , 1 PURPOSE To assess the effect of platelet-rich plasma fibrin matrix ( PRPFM ) construct augmentation on postoperative tendon healing as determined by magnetic resonance imaging ( MRI ) and clinical outcome of arthroscopic rotator cuff repair . METHODS A comparative series of patients undergoing arthroscopic rotator cuff repair was studied . Two matched groups of patients ( 20 each ) were included : rotator cuff repairs without PRPFM augmentation ( group 1 ) and  rotator cuff repairs augmented with 2 sutured platelet-rich plasma ( PRP ) constructs ( group 2 ) . A single-row cuff repair to the normal footprint without tension or marrow vents was performed by a single surgeon . Postoperative rehabilitation was held constant . Postoperative MRI scans were used to evaluate rotator cuff healing . Outcome measures included American Shoulder and Elbow Surgeons , Rowe , Single Assessment Numeric Evaluation , Simple Shoulder Test , and Constant scores . RESULTS We followed up 40 patients ( 2 matched groups with 20 patients each ) with a mean age of 57 years ( range , 44 to 69 years ) for a mean of 31 months ( range , 24 to 44 months ) . Postoperative MRI studies showed persistent full-thickness tendon defects in 60 % of controls ( 12 of 20 ) and 30 % of PRPFM-augmented repairs ( 6 of 20 ) ( P = .03 ) . Of the control group tears measuring less than 3 cm in anteroposterior length , 50 % ( 7 of 14 ) healed fully , whereas 86 % of the PRPFM group tears measuring less than 3 cm in anteroposterior length ( 12 of 14 ) healed fully ( P < .05 ) . There was no significant difference between groups 1 and 2 in terms of American Shoulder and Elbow Surgeons ( 94.7 and 95.7 , respectively ; P = .35 ) , Single Assessment Numeric Evaluation ( 93.7 and 94.5 , respectively ; P = .37 ) , Simple Shoulder Test ( 11.4 and 11.3 , respectively ; P = .41 ) , and Constant ( 84.7 and 88.1 , respectively ; P = .19 ) scores . The Rowe scores ( 84.8 and 94.9 , respectively ; P = .03 ) were statistically different . CONCLUSIONS The addition of 2 PRPFM constructs sutured into a primary rotator cuff tendon repair result ed in lower retear rates identified on MRI than repairs without the constructs . Other than the Rowe scores , there was no postoperative clinical difference by use of st and ard outcome measures . LEVEL OF EVIDENCE Level III , case-control study
BACKGROUND Platelet-rich plasma ( PRP ) has gained significant interest in recent years to potentially add biological augmentation of healing to surgical repairs of soft-tissue injuries .
We sought to determine whether perioperative PRP injection influences the risk of failure following rotator cuff repair .