Abstract
BackgroundRecently, many authors have reported the effects of platelet-rich plasma (PRP) on rotator cuff repair. Whether PRP treatment during arthroscopic rotator cuff repair improves tendon healing rates or restores full function remains unknown. The purpose of this meta-analysis was to evaluate the clinical improvement and radiological outcomes of PRP treatment in patients undergoing arthroscopic rotator cuff repair.MethodsPubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were searched. The study included only level 1 or 2 randomized controlled trials (RCTs) that compared the injection of platelet-rich plasma or platelet-rich fibrin matrix. The methodological quality of the trials was assessed using the Cochrane Handbook for Systematic Reviews of Interventions, 5.3. Continuous variables were analysed using the weighted mean difference, and categorical variables were assessed using relative risks. P < 0.05 was considered statistically significant.ResultsThe meta-analysis revealed a lower retear rate following PRP treatment than that following the control method (mean difference, 1.10; 95% CI, 1.03 to 1.18; P = 0.004). Constant shoulder scores improved with PRP (mean difference, 2.31; 95% CI, 1.02 to 3.61; P = 0.0005). PRP treatment also resulted in higher UCLA scores (mean difference, 0.98; 95% CI, 0.27 to 1.69; P = 0.007), and simple shoulder test scores were improved (mean difference, 0.43; 95% CI, 0.11 to 0.75; P = 0.008). Finally, lower visual analogue scale scores were observed with PRP augmentation (mean difference, − 0.35; 95% CI, − 0.57 to − 0.13; P = 0.002).ConclusionsThe current systematic review and meta-analysis reveals that PRP treatment with arthroscopic repair of rotator cuff tears decreases the retear rate and improves the clinical outcomes.Systematic review registrationPROSPERO CRD42016048416
Highlights
The use of autologous platelet-rich plasma (PRP) or similar products containing platelets has been widely studied in bone and tendon tissue healing and reconstruction [1–5]
PRP is known to contain more than 1500 bioactive proteins that are important for tendon healing, including growth factors such as transforming growth factor beta (TGF-ß), fibroblast growth factor (FGF), and platelet-derived growth factor (PDGF) [6, 7]
Significant differences were found in the fixed effects model between the PRP+ and PRP− treatment groups at the last follow-up along their respective recovery paths (P = 0.0005). These data suggest that constant shoulder score improvement may be accelerated by PRP treatment in arthroscopic repair of rotator cuff tears
Summary
The use of autologous platelet-rich plasma (PRP) or similar products containing platelets has been widely studied in bone and tendon tissue healing and reconstruction [1–5]. PRP, glucocorticoids, local anaesthetics, or hyaluronic acid are used to reduce pain and improve performance in patients who undergo rotator cuff repair. Local anaesthetics and glucocorticoids have cytotoxic effects on tenocytes, and hyaluronic acid decreases pain in patients with partial tear of the rotator cuff tendons [8]. Many authors have reported the effects of PRP on partial or complete tears of rotator cuff tendons [9–11]. These trials returned mixed results [9– 14] and were unable to show consistently improved retear rates or improved clinical outcome scores. Whether PRP treatment during arthroscopic rotator cuff repair improves tendon healing rates or restores full function remains unknown. The purpose of this meta-analysis was to evaluate the clinical improvement and radiological outcomes of PRP treatment in patients undergoing arthroscopic rotator cuff repair
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