Impact of Platelet-Rich Plasma on Arthroscopic Repair of Small- to Medium-Sized Rotator Cuff Tears: A Randomized Controlled Trial

Richard Holtby; Monique Christakis; Eran Maman; Joy C MacDermid; Tim Dwyer; George S Athwal; Kenneth Faber; John Theodoropoulos; Linda J Woodhouse; Helen Razmjou

doi:10.1177/2325967116665595

Impact of Platelet-Rich Plasma on Arthroscopic Repair of Small- to Medium-Sized Rotator Cuff Tears: A Randomized Controlled Trial

Orthop J Sports Med. 2016 Sep 13;4(9):2325967116665595. doi: 10.1177/2325967116665595. eCollection 2016 Sep.

Authors

Affiliations

¹ Division of Orthopedic Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.; Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
² Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.; Department of Medical Imaging, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
³ Shoulder Unit, Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
⁴ Department of Physical Therapy, Western University, London, Ontario, Canada.; Roth McFarlane Hand and Upper Limb Centre, St Joseph's Health Centre, London, Ontario, Canada.
⁵ Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.; Division of Orthopedic Surgery, Department of Surgery, Women's College and Mount Sinai Hospital, Toronto, Ontario, Canada.
⁶ Roth McFarlane Hand and Upper Limb Centre, St Joseph's Health Centre, London, Ontario, Canada.; Division of Orthopaedic Surgery, Department of Surgery, Western University, London, Ontario, Canada.
⁷ Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada.; McCaig Institute for Bone and Joint Health, Calgary, Alberta, Canada.
⁸ Department of Rehabilitation, Holland Orthopedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.; Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.

Abstract

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: Randomized controlled trial; Level of evidence, 1.

Methods: This was a double-blinded randomized 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 randomized 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 clinically 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.

Keywords: healing; platelet-rich plasma; rotator cuff.