Double-Row Rotator Cuff Repair Enhanced With Platelet-Rich Therapy Reduces Retear Rate: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Purpose: To assess retear rates in arthroscopic double-row rotator cuff repair (double-row RCR) with and without platelet-rich therapy (PRT). Methods: Systematic review and meta-analysis of randomized controlled trials (RCTs). MEDLINE, Embase, and Scopus databases were searched for RCTs involving use of PRT exclusively in arthroscopic doublerow RCR. A random-effects model and the generic inverse variance method were used for quantitative data synthesis. Heterogeneity was tested with the I2 statistic index. Results: The 9 RCTs included in the meta-analysis demonstrated a risk reduction of 49% for retears in patients receiving PRT (risk ratio [RR] 0.51; 95% confidence interval [CI] 0.35 to 0.76; P = .0008; I2 = 0%). Divided by tear sizes, retear risk reduction of 47% (RR 0.53; 95% CI 0.30 to 0.95; P = .03; I2 = 0%) was found in small to medium tears and 51% (RR 0.49; 95% CI 0.29 to 0.84; P = .009; I2 = 0%) in large to massive tears. Linked double-row RCR resulted in risk reduction of 51% for retears in comparison with nonlinked repairs. Conclusion: Double-row RCR plus PRT significantly reduced retear rates in all sizes of rotator cuff tears. Linked double-row RCR and applying the PRT during the surgical procedure and in the tendon-bone interface reproduced the best outcomes. Clinically, all patients improved, and no statistically significant difference was seen in clinical and functional scores between the intervention groups. All patients achieved optimal values for patient-reported outcomes measures. Level of Evidence: I, systematic review and meta-analysis of level I studies.

Automated summary

The meta-analysis of 9 RCTs showed that using PRT in double-row RCR can significantly reduce retear rates in all sizes of rotator cuff tears. The best outcomes were seen in linked double-row RCR and when PRT was applied during the surgical procedure and in the tendon-bone interface. All patients improved clinically and achieved optimal values for patient-reported outcomes measures.