Rotator Cuff Healing With and Without Platelet Rich Plasma Application (SS-16)

Abstract

Introduction The purpose of this study was to compare rotator cuff footprint healing rates after arthroscopic, single row, triple loaded suture anchor repair with and without the addition of platelet rich plasma. The primary hypothesis was that the addition of platelet rich plasma to the repair would not affect the healing time of the rotator cuff footprint as determined by postoperative shoulder ultrasound. Methods This was a prospective cohort study with 50 patients in each cohort. The first cohort was filled by taking 50 consecutive patients with rotator cuff tears up to 3 cm in length and applying 5-6 cc of autologous platelet rich plasma at the tendon-bone interface at the end of the surgical procedure under arthroscopic guidance. The platelet rich plasma was autologous and prepared with a commercially available kit. The second cohort was also a consecutive series of 50 patients with tears up to 3 cm and these patients did not receive platelet rich plasma. Patients in both cohorts had rotator cuff tears involving either the supraspinatus tendon only, or the supraspinatus and infraspinatus tendons. The rotator cuff tear measured up to 3 cm in anterior-posterior dimension. The surgeon and surgical techniques and implants and suture were identical between the two cohorts. There was no significant difference between the cohort groups in gender, age, or tobacco use. All rotator cuff tears were repaired with at least one triple loaded metal suture anchor. If the tear pattern required it, additional suture anchors and/or side to side sutures were also used to repair the tendon. Patients in both cohorts were evaluated with in office shoulder ultrasound at 6 weeks 3 months, and 6 months after surgery at which time a determination of rotator cuff footprint healing was recorded. Results The cohort group with platelet rich plasma application was designated PRP(+) and the cohort group without platelet rich plasma was designated PRP(-). The PRP(+) group had 48 patients with healed tendons with a mean healing time of 13.75 weeks and a standard deviation of 5.25 weeks. The PRP(-) group had 47 patients with healed tendons with a mean healing time of 14.83 weeks and a standard deviation of 5.57 weeks. ANOVA statistical analysis revealed that there was no statistically significant difference between the cohort group mean healing times. Additionally, the Tukey value of 1.38 further supported our acceptance of the null hypothesis that the difference in mean values was not statistically significant. Conclusion The addition of autologous platelet-rich plasma in a single application at the time of rotator cuff repair did not have a statistically significant effect on the footprint healing time as determined by ultrasound evaluation. Based on the cohort criteria and our surgical techniques, we conclude that in arthroscopic rotator cuff repairs less than 3 cm repaired with a triple-loaded suture anchor in a single row, the addition of platelet rich plasma in a single dose at the time of surgery was not successful in shortening the healing time of the rotator cuff tendon. The purpose of this study was to compare rotator cuff footprint healing rates after arthroscopic, single row, triple loaded suture anchor repair with and without the addition of platelet rich plasma. The primary hypothesis was that the addition of platelet rich plasma to the repair would not affect the healing time of the rotator cuff footprint as determined by postoperative shoulder ultrasound. This was a prospective cohort study with 50 patients in each cohort. The first cohort was filled by taking 50 consecutive patients with rotator cuff tears up to 3 cm in length and applying 5-6 cc of autologous platelet rich plasma at the tendon-bone interface at the end of the surgical procedure under arthroscopic guidance. The platelet rich plasma was autologous and prepared with a commercially available kit. The second cohort was also a consecutive series of 50 patients with tears up to 3 cm and these patients did not receive platelet rich plasma. Patients in both cohorts had rotator cuff tears involving either the supraspinatus tendon only, or the supraspinatus and infraspinatus tendons. The rotator cuff tear measured up to 3 cm in anterior-posterior dimension. The surgeon and surgical techniques and implants and suture were identical between the two cohorts. There was no significant difference between the cohort groups in gender, age, or tobacco use. All rotator cuff tears were repaired with at least one triple loaded metal suture anchor. If the tear pattern required it, additional suture anchors and/or side to side sutures were also used to repair the tendon. Patients in both cohorts were evaluated with in office shoulder ultrasound at 6 weeks 3 months, and 6 months after surgery at which time a determination of rotator cuff footprint healing was recorded. The cohort group with platelet rich plasma application was designated PRP(+) and the cohort group without platelet rich plasma was designated PRP(-). The PRP(+) group had 48 patients with healed tendons with a mean healing time of 13.75 weeks and a standard deviation of 5.25 weeks. The PRP(-) group had 47 patients with healed tendons with a mean healing time of 14.83 weeks and a standard deviation of 5.57 weeks. ANOVA statistical analysis revealed that there was no statistically significant difference between the cohort group mean healing times. Additionally, the Tukey value of 1.38 further supported our acceptance of the null hypothesis that the difference in mean values was not statistically significant. The addition of autologous platelet-rich plasma in a single application at the time of rotator cuff repair did not have a statistically significant effect on the footprint healing time as determined by ultrasound evaluation. Based on the cohort criteria and our surgical techniques, we conclude that in arthroscopic rotator cuff repairs less than 3 cm repaired with a triple-loaded suture anchor in a single row, the addition of platelet rich plasma in a single dose at the time of surgery was not successful in shortening the healing time of the rotator cuff tendon.