Application of Platelet-Rich Plasma in Arthroscopic Rotator Cuff Repair. A Systematic Review and Meta-analysis
Platelet-rich plasma (PRP) has attracted significant attention in the field of orthopedics, particularly in procedures related to tendon repair. PRP contains a high concentration of growth factors and cytokines that may promote tissue healing and regeneration. The use of PRP in rotator cuff repairs (RCR) has emerged as a promising intervention to enhance surgical outcomes. Despite the increasing popularity of PRP, there remains controversy regarding its effectiveness, hence the need for prospective randomized controlled trials (RCTs) to generate solid evidence.
Methodology of Studies
RCTs examining the application of PRP in RCR are designed to reduce bias and yield high-quality evidence. The studies typically randomize patients undergoing RCR into two groups: one receiving PRP application during surgery, and the other receiving standard treatment without PRP. Outcomes are evaluated using a variety of metrics, including pain scores, functional scores (such as the Constant-Murley Score and the American Shoulder and Elbow Surgeons Score), imaging to assess the healing of the rotator cuff, and rates of re-tear or complications.
Findings of RCTs on PRP in RCR
RCTs evaluating the use of PRP in RCR have produced mixed results. Some studies found a significant improvement in postoperative pain scores, shoulder function, and lower re-tear rates in the PRP group compared to the control. However, other RCTs have failed to demonstrate any significant difference between PRP and control groups in terms of functional scores or re-tear rates.
One major finding from these RCTs is the influence of the PRP preparation technique on the results. Studies using leukocyte-rich PRP (L-PRP) tend to report better outcomes than those using leukocyte-poor PRP (P-PRP), suggesting that the presence of leukocytes may be crucial to the PRP’s efficacy in rotator cuff healing.
Challenges in the Current Research
Despite the number of studies, heterogeneity remains an issue in the research landscape. The preparation and application techniques of PRP, dosage, timing of application, and the characteristics of patients included in these trials differ significantly, leading to inconsistencies in findings. Additionally, the blinding of patients and assessors is often challenging due to the distinct appearance and application procedure of PRP.
Conclusion and Future Directions
As of now, the application of PRP in RCR is a promising but not definitively proven approach. The mixed results from RCTs do not support a robust, universal endorsement of PRP usage in RCR. It is essential for future studies to standardize PRP preparation and application techniques, as well as to stratify patients according to the severity of their rotator cuff tears.
Moreover, given the potential role of leukocytes in enhancing the efficacy of PRP, future research should also investigate the optimal balance between platelets and leukocytes. With these considerations, the true potential of PRP in improving rotator cuff repair outcomes could be better discerned, leading to more effective and personalized treatment strategies for patients with rotator cuff injuries.