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.

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.

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

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