Sports Medicine Research: In the Lab & In the Field: Platelet-Rich Plasma, is it Beneficial in Shoulder Surgery? (Sports Med Res)


Monday, November 4, 2013

Platelet-Rich Plasma, is it Beneficial in Shoulder Surgery?

Platelet-Rich Plasma for Arthroscopic Repair of Large to Massive Rotator Cuff Tears

Jo CH, Shin JS, Lee YG, et al. The American Journal of Sports Medicine. 2013;41;2240-2249.

Take Home Message: In this randomized controlled study, researchers found that the inclusion of platelet-rich plasma for huge rotator cuff decreased retear rate and resulted in a slight increase in cross-sectional area of the supraspinatus a year following surgery.

Platelet-rich plasma (PRP) is commonly incorporated into surgical procedures to help with healing of various tissues. However, the true effect of PRP is still largely unknown. The purpose of this randomized controlled trial was to assess the efficacy of PRP in patients undergoing arthroscopic repair of a large to massive rotator cuff tear (>30mm anteroposterior size). The authors randomly assigned 48 patients between the ages of 45 and 84 years into PRP-augmented or conventional treatments groups. The primary outcome measure was the retear rate 1-year post surgery. Secondary outcomes measured pre-surgery, immediately post-surgery, and 1-year post surgery included clinical outcomes (e.g., pain, range of motion, strength) and the cross-sectional area (CSA) of the supraspinatus. At a year post-surgery, the PRP group (20%) had a lower retear rate than the conventional group (56%). Pain, range of motion, strength, and CSA of the supraspinatus were not different between groups pre-surgery, immediately post-surgery, or 1-year post-surgery. However, the PRP group reported greater improvement in function at 1-year post-surgery compared with the conventional group.

This study found that a patient who received PRP was less likely to retear his/her rotator cuff compared with a patient that received conventional treatment. As a clinician, this is particularly important because no patient wants to retear the rotator cuff and be at risk for recurrent shoulder symptoms. However, a limitation of this study is the relatively short follow-up. One year may not be enough time to adequately assess the use of PRP during arthroscopic repair of a large to massive rotator cuff tear. While patients in the PRP group experienced less retears and more self-reported function at 1 year post-surgery, both groups had comparable clinical outcomes (e.g., pain, strength). If both groups have similar improvements this raises an interesting question: is it worth the extra money for PRP? Unfortunately, this study only looked at arthroscopic repairs for large to massive tears so we cannot generalize these results to other pathologies and surgeries. But among these patients, PRP may be beneficial in the sense of retear rates but overall, it may not be as life-altering as we think.

Questions for Discussion: As a clinician, what are your experiences with PRP? Besides the retear rate, none of the clinical outcomes differed between groups; with that said, do you believe PRP should be used in surgical procedures? 

Written by: Carolin Suon
Reviewed by: Lisa Chinn and Jeffrey Driban

Related Posts:

Jo CH, Shin JS, Lee YG, Shin WH, Kim H, Lee SY, Yoon KS, & Shin S (2013). Platelet-rich plasma for arthroscopic repair of large to massive rotator cuff tears: a randomized, single-blind, parallel-group trial. The American Journal of Sports Medicine, 41 (10), 2240-8 PMID: 23921338


Erika Spudie said...

Although the clinical outcomes were not different between groups, the outcomes that were influenced are enough to warrant the use of PRP for this procedure, in my opinion. The test group had significantly fewer re-tears in a single year, which I think is enough to convince a patient to use the method. The process of surgery and rehabilitation are physically and emotionally taxing, and the potential of avoiding that process again seems like reasonable motivation. I'm interested to see what the longer term outcomes will be, perhaps five or ten years following the procedure, to see if the PRP affects the long term health of the tissue.
PRP seems promising, and it will be interesting to see what future literature reveals. However, the biggest disadvantage to using PRP is that it is still considered to be an "experimental" procedure , which keeps it from being covered by most insurance plans (to my knowledge). More high-quality RCTs such as this will aid in removing the barrier from PRP being used more regularly in surgical procedures.

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