4.6 Article

Platelet-Rich Plasma for Arthroscopic Repair of Large to Massive Rotator Cuff Tears A Randomized, Single-Blind, Parallel-Group Trial

Journal

AMERICAN JOURNAL OF SPORTS MEDICINE
Volume 41, Issue 10, Pages 2240-2248

Publisher

SAGE PUBLICATIONS INC
DOI: 10.1177/0363546513497925

Keywords

platelet-rich plasma; large to massive rotator cuff tear; rotator cuff repair; biological augmentation; retear; integrity

Funding

  1. National Research Foundation (NRF) [2011-0022184, 2011-0019773]
  2. Korean Government (MEST)
  3. National Research Foundation of Korea [2011-0019773, 2011-0022184] Funding Source: Korea Institute of Science & Technology Information (KISTI), National Science & Technology Information Service (NTIS)

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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: Randomized controlled trial; Level of evidence, 1. Methods: A total of 48 patients scheduled for arthroscopic repair of large to massive rotator cuff tears were randomly assigned to receive either PRP-augmented (PRP group) or conventional treatment (conventional group). In the PRP group, 3 PRP gels (3 x 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 mm(2) in the PRP group versus -85.62 +/- 103.57 mm(2) in the conventional group (P = .047). Conclusion: The application of PRP for large to massive rotator cuff repairs significantly improved structural outcomes, as evidenced 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.

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