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Am J Sports Med. 2015 Dec;43(12):3071-6. doi: 10.1177/0363546515572777. Epub 2015 Mar 12.

Platelet-Rich Plasma Reduces Retear Rates After Arthroscopic Repair of Small- and Medium-Sized Rotator Cuff Tears but Is Not Cost-Effective.

Author information

1
Division of Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA Harvard Center for Population and Development Studies, Harvard School of Public Health, Boston, Massachusetts, USA Department of Orthopaedic Surgery, University Hospital Basel, Basel, Switzerland patrick.vavken@childrens.harvard.edu.
2
Department of Orthopaedic Surgery, Medical University Graz, Graz, Austria.
3
Harvard Business School, Cambridge, Massachusetts, USA.
4
Department of Orthopaedic Surgery, University Hospital Basel, Basel, Switzerland ALTIUS Swiss Sportmed Center, Basel, Switzerland.
5
Department of Orthopaedic Surgery, University Hospital Basel, Basel, Switzerland.

Abstract

BACKGROUND:

It has been suggested that platelet-rich plasma (PRP) improves healing after arthroscopic rotator cuff repair. The current literature provides ample but inconsistent data on this topic.

PURPOSE:

To systematically review the current in vivo evidence for the use of platelet concentrates (PRP) in the arthroscopic treatment of rotator cuff tears to assess effectiveness, safety, and cost-effectiveness.

STUDY DESIGN:

Meta-analysis and cost-effectiveness analysis.

METHODS:

Published evidence from controlled, human trials of rotator cuff repair augmented with platelet concentrates was systematically gathered, and data on retear rates were extracted. Mathematical and clinical heterogeneity was evaluated, and fixed-effect meta-analysis was performed to calculate the risk ratio (RR) of retears and the number needed to treat (NNT). Subgroup analyses were made for small/medium tears (n = 404) and large/massive tears (n = 374). Cost-effectiveness was assessed using data from this meta-analysis and using cost data from the literature, including extensive sensitivity analyses, to calculate the incremental cost-effectiveness ratio (ICER).

RESULTS:

Thirteen studies published between 2010 and 2014 were identified for analysis. The RR for retear for all patients was 0.87 (95% CI, 0.67-1.12; P = .286). For small- and medium-sized tears (<3 cm), the RR for retear was 0.60 (95% CI, 0.37-0.97), consistent with a significant difference in favor of PRP use (P = .038). This translated into an NNT of 14 (95% CI, 7-125). However, at an ICER of US$127,893 per quality-adjusted life year gained, assuming a 5% revision rate, the use of PRP was not cost-effective for small- and medium-sized tears.

CONCLUSION:

In large tears, even with double-row repair, the beneficial effects of PRP alone are insufficient to compensate the progressed tissue damage. The study data suggest that PRP may promote healing of small- and medium-sized tears to reduce retear rates. However, despite the substantial biological effect, at current cost, the use of PRP is not cost-effective in arthroscopic repair of small- and medium-sized tears.

KEYWORDS:

PRP; cost-effectiveness; evidence-based medicine; platelet; rotator cuff

PMID:
25767267
DOI:
10.1177/0363546515572777
[Indexed for MEDLINE]

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