The Efficacy of Platelet-Rich Plasma and
Platelet-Rich Fibrin in Arthroscopic Rotator Cuff Repair: A Meta-analysis of
Randomized Controlled Trials
Hurley ET, Lim Fat D, Moran CJ, Mullett H. Am J
Sports Med. 2018 Feb 1:363546517751397. doi: 10.1177/0363546517751397.
[Epub ahead of print]
Text Freely Available
Take Home Message:
A platelet-rich plasma injection – but not a platelet-rich fibrin injection – during
arthroscopic rotator cuff repair improves clinical and patient-reported
outcomes compared to controls.
Platelet-rich therapies
(e.g., platelet-rich plasma [PRP] or platelet-rich fibrin [PRF]) in adjunct
with arthroscopic rotator cuff repair surgeries are growing in popularity. PRP
primarily mediates growth factors, which facilitate healing through connective
tissue growth, restoring oxygen in vessels, and cell division. PRF is a newer
technique, which contains less platelets and more fibrin clotting factors, thus
expediting the clotting at the tendon repair site. However, we lack
recommendations for using 
platelet-rich therapies during surgical interventions
despite basic science studies that show their promise for tendon healing. Hence,
the authors performed a meta-analysis of randomized trials to assess the
efficacy of PRP or PRF in arthroscopic rotator cuff repair. Two reviewers
identified 18 clinical trials with 1,147 participants. The authors extracted results
on incomplete tendon healing in all size tears (small, medium, large), patient
satisfaction, and visual analog scale for pain at 30 days and final follow
up.  Overall, PRP improves pain,
functional outcomes, and tendon healing rates (regardless of tear size). At one
month post-surgery, participants with PRP typically reported a clinically meaningful
reduction of pain on a visual analog scale of 1.4 points compared with control participants.
Conversely, participants who received PRF therapy failed to experience any
benefits, with one study reporting adverse effects.
The growing acceptance of platelet-rich therapies in surgical interventions is inspired by growing basic
science evidence that 
platelet-rich therapies improve tendon healing rates. The
ability of PRP therapies to benefit complete tissue healing could drastically
shift the post-operative paradigm of rotator cuff repair rehabilitation.
Complete tissue healing begets decreased pain levels, which in turn begets
increased functional activity outcomes. While this routine therapy seems
flawless, clinicians need to recognize several limitations to PRP. Preparation
and deliverance of PRP and PRF vary considerably in overall composition of
platelet count, leukocyte count, and concentrations of growth factors. Without
a standardized dosage of PRP or PRF, a universal protocol for these therapies
are far from being accepted. Additionally, PRP injections range in cost between
$500 and $2000 and are still an out-of-pocket expense for the patient since the
treatment lacks sufficient evidence for insurance to cover it. Furthermore, 
therapies can be delivered post-operatively via injection and those effects
have yet to be intensively studied or compared to intra-operative use. Despite
these limitations, the inclusion of a PRP treatment during arthroscopic rotator
cuff repair may be advantageous for improving healing rates and patient-reported
Questions for Discussion:
Would you recommend your patients to seek 
platelet-rich therapies during arthroscopic rotator cuff
repair? If your patient did receive PRP or PRF during surgery, did you notice a
difference in recovery between a patient who did not?
Written by: Danielle M. Torp
Reviewed by: Jeffrey