Clinical and Structural Evaluations of Rotator Cuff Repair With and Without Added Platelet-Rich Plasma at 5-Year Follow-up: A Prospective Randomized Study

• Published in: The American journal of sports medicine Vol. 46; no. 13; pp. 3134 - 3141
• Main Authors: Malavolta, Eduardo Angeli, Gracitelli, Mauro Emilio Conforto, Assunção, Jorge Henrique, Ferreira Neto, Arnaldo Amado, Bordalo-Rodrigues, Marcelo, de Camargo, Olavo Pires
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-11-2018; Sage Publications Ltd
• Subjects: Rotator cuff; Sports medicine; clinical outcomes; magnetic resonance imaging; rotator cuff repair; arthroscopic surgery; tendon healing; platelet-rich plasma
• ISSN: 0363-5465; 1552-3365
• DOI: 10.1177/0363546518795895

Background:
Platelet-rich plasma (PRP) has been studied with the objective of reducing the retear rate and improving functional outcomes after rotator cuff repair. Only one study to date has reported its midterm effect.
Hypothesis:
PRP promotes better functional and structural results in arthroscopic rotator cuff repair.
Study Design:
Randomized controlled trial; Level of evidence, 2.
Methods:
All patients underwent arthroscopic single-row repair of small to medium supraspinatus tears. At the end of the surgical procedure, liquid PRP prepared by apheresis with autologous thrombin was applied in the tendon-to-bone interface in the PRP group. The outcomes were assessed by the University of California, Los Angeles (UCLA) and Constant scales and the visual analog scale (VAS) for pain at 6, 12, 24, and 60 months after surgery and magnetic resonance imaging at 12 and 60 months.
Results:
Of 54 patients initially randomized, we analyzed the clinical outcomes in 51 (25 control, 26 PRP) and the structural outcomes in 44 (22 each group). At 60-month follow-up, the mean UCLA scores were 32.5 ± 3.8 and 32.1 ± 4.6 in the control and PRP groups, respectively (P = .992). The mean Constant scores were 82.0 ± 9.5 in the control group and 82.1 ± 11.0 in the PRP group (P = .699). The mean VAS scores were 1.4 ± 1.8 and 1.5 ± 2.1 in the control and PRP groups, respectively (P = .910). None of the clinical assessments at 6, 12, and 24 months in either group produced statistically significant differences, and both groups showed significant improvements throughout the follow-up time in the 3 evaluations (P < .001). The control group exhibited 1 full-thickness retear (Sugaya type IV) and 11 partial-thickness retears (Sugaya type III), while the PRP group had 7 partial-thickness retears (Sugaya type III). The overall number of retears did not differ between groups (P = .203).
Conclusion:
PRP obtained by apheresis and applied in liquid form with the addition of thrombin at the end of single-row repair of supraspinatus tears did not promote better clinical or structural results at 60-month follow-up.
Registration:
NCT01029574 (ClinicalTrials.gov identifier)