Effects of platelet-rich plasma in arthroscopic full-thickness rotator cuff repair: a meta-analysis_West China Medical Journal

Authors：

 LIU Kai , WANG Yongcai , HUANG Qiu , WANG Hongchuan , JIANG Junwei

Department of Orthopedics, People’s Hosipital of Leshan, Leshan, Sichuan 614000, P. R. China;

Corresponding?author：

LIU Kai, Email: 285061643@qq.com

Keywords：

Platelet-rich plasma; Arthroscopy; Full-thickness rotator cuff repair; Clinical effect; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1002-0179.201910015

Video：

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Objective To evaluate the clinical effectiveness and safety of platelet-rich plasma (PRP) in the arthroscopic repair of full-thickness rotator cuff injury.Methods Relevant randomized controlled trials were identified from Cochrane Library, PubMed, Embase, China Biology Medicine Database, Chongqing VIP Database, China National Knowledge Infrastructure, and Wanfang Database (from the dates of establishment to September 2020). A systematic review was performed to compare the short-term and mid-term retear rates, the scores of the University of California at Los Angeles (UCLA) Shoulder Rating Scale, and the scores of Visual Analogue Scale (VAS) between the two groups. Analyses were conducted using RevMan 5.2.0 software.Results Nine studies with low heterogeneity were included in the meta-analysis involving 610 cases (305 in the PRP group and 305 in the control group). There were significant differences in the short-term retear rate [relative risk (RR)=0.29, 95% confidence interval (CI) (0.13, 0.65), P=0.003], the short-term and the mid-term UCLA scores [standardized mean difference (SMD)=0.35, 95%CI (0.14, 0.56), P=0.000 9; SMD=0.87, 95%CI (0.53, 1.21), P<0.000 01], the short-term and the mid-term VAS scores [SMD=?0.29, 95%CI (?0.51, ?0.07), P=0.009; SMD=?0.35, 95%CI (?0.66, ?0.03), P=0.03] between the two groups. There was no significant difference in the mid-term retear rate [RR=0.88, 95%CI (0.48, 1.63), P=0.69] or complication rate [RR=1.40, 95%CI (0.78, 2.54), P=0.26] between the two groups.Conclusions PRP injection can effectively improve the clinical outcomes following arthroscopic repair of full-thickness rotator cuff tears, thus reducing the short-term retear rate, alleviating pain, and improving patients’ shoulder function.

Citation： LIU Kai, WANG Yongcai, HUANG Qiu, WANG Hongchuan, JIANG Junwei. Effects of platelet-rich plasma in arthroscopic full-thickness rotator cuff repair: a meta-analysis. West China Medical Journal, 2020, 35(10): 1212-1218. doi: 10.7507/1002-0179.201910015 Copy

1.	El-Azab H, Buchmann S, Beitzel K, et al. Clinical and structural evaluation of arthroscopic double-row suture-bridge rotator cuff repair: early results of a novel technique. Knee Surg Sports Traumatol Arthrosc, 2010, 18(12): 1730-1737.
2.	Charles MD, Christian DR, Cole BJ. The role of biologic therapy in rotator cuff tears and repairs. Curr Rev Musculoskelet Med, 2018, 11(1): 150-161.
3.	劉巖, 張皓序, 劉付龍, 等. 注射富血小板血漿促進部分肩袖損傷的修復:基礎研究與臨床試驗. 中國組織工程研究, 2019, 23(3): 487-492.
4.	孫程, 桑偉林, 馬金忠. 富血小板血漿對關節鏡下肩袖修補安全性和有效性影響的Meta分析與系統評價. 中華關節外科雜志(電子版), 2016, 10(6): 645-653.
5.	李雪迎. Meta 分析研究設計中的 PICOS 原則. 中國介入心臟病學雜志, 2016, 24(11): 611.
6.	Han C, Na YY, Zhu Y, et al. Is platelet-rich plasma an ideal biomaterial for arthroscopic rotator cuff repair? A systematic review and meta-analysis of randomized controlled trials. J Orthop Surg Res, 2019, 14(1): 183.
7.	Randelli P, Arrigoni P, Ragone V, et al. Platelet rich plasma in arthroscopic rotator cuff repair: a prospective RCT study, 2-year follow-up. J Shoulder Elbow Surg, 2011, 20(4): 518-528.
8.	Jo CH, Shin JS, Lee YG, et al. Platelet-rich plasma for arthroscopic repair of large to massive rotator cuff tears: a randomized, single-blind, parallel-group trial. Am J Sports Med, 2013, 41(10): 2240-2248.
9.	Malavolta EA, Gracitelli ME, Ferreira Neto AA, et al. Platelet-rich plasma in rotator cuff repair: a prospective randomized study. Am J Sports Med, 2014, 42(10): 2446-2454.
10.	Jo CH, Shin JS, Shin WH, et al. Platelet-rich plasma for arthroscopic repair of medium to large rotator cuff tears: a randomized controlled trial. Am J Sports Med, 2015, 43(9): 2102-2110.
11.	董佩龍, 唐曉波, 王健, 等. 自體富血小板血漿凝膠在關節鏡下肩袖修補術中的應用. 中華骨科雜志, 2015, 35(9): 942-947.
12.	Flury M, Rickenbacher D, Schwyzer H, et al. Does pure platelet-rich plasma affect postoperative clinical outcomes after arthroscopic rotator cuff repair? A randomized controlled trial. Am J Sports Med, 2016, 44(8): 2136-2146.
13.	Pandey V, Bandi A, Madi S, et al. Does application of moderately concentrated platelet-rich plasma improve clinical and structural outcome after arthroscopic repair of medium-sized to large rotator cuff tear? A randomized controlled trial. J Shoulder Elbow Surg, 2016, 25(8): 1312-1322.
14.	Zhang ZX, Wang Y, Sun JY. The effect of platelet-rich plasma on arthroscopic double-row rotator cuff repair: a clinical study with 12-month follow-up. Acta Orthop Traumatol Turc, 2016, 50(2): 191-197.
15.	Ebert JR, Wang A, Smith A, et al. A midterm evaluation of postoperative platelet-rich plasma injections on arthroscopic supraspinatus repair: a randomized controlled trial. Am J Sports Med, 2017, 45(13): 2965-2974.
16.	Dohan Ehrenfest DM, Andia I, Zumstein MA, et al. Classification of platelet concentrates (platelet-rich plasma-PRP, platelet-rich fibrin-PRF) for topical and infiltrative use in orthopedic and sports medicine: current consensus, clinical implications and perspectives. Muscles Ligaments Tendons J, 2014, 4(1): 3-9.
17.	劉宇, 顧三軍, 徐耀增. 巨大肩袖損傷的診治現狀與進展. 中華創傷骨科雜志, 2018, 20(9): 823-828.
18.	Martinelli D, Fornara P, Stecco A, et al. Does intraoperative platelet-rich plasma improve clinical and structural outcomes after arthroscopic repair of isolated tears of the supraspinatus tendon?. Indian J Orthop, 2019, 53(1): 77-81.

1. El-Azab H, Buchmann S, Beitzel K, et al. Clinical and structural evaluation of arthroscopic double-row suture-bridge rotator cuff repair: early results of a novel technique. Knee Surg Sports Traumatol Arthrosc, 2010, 18(12): 1730-1737.
2. Charles MD, Christian DR, Cole BJ. The role of biologic therapy in rotator cuff tears and repairs. Curr Rev Musculoskelet Med, 2018, 11(1): 150-161.
3. 劉巖, 張皓序, 劉付龍, 等. 注射富血小板血漿促進部分肩袖損傷的修復:基礎研究與臨床試驗. 中國組織工程研究, 2019, 23(3): 487-492.
4. 孫程, 桑偉林, 馬金忠. 富血小板血漿對關節鏡下肩袖修補安全性和有效性影響的Meta分析與系統評價. 中華關節外科雜志(電子版), 2016, 10(6): 645-653.
5. 李雪迎. Meta 分析研究設計中的 PICOS 原則. 中國介入心臟病學雜志, 2016, 24(11): 611.
6. Han C, Na YY, Zhu Y, et al. Is platelet-rich plasma an ideal biomaterial for arthroscopic rotator cuff repair? A systematic review and meta-analysis of randomized controlled trials. J Orthop Surg Res, 2019, 14(1): 183.
7. Randelli P, Arrigoni P, Ragone V, et al. Platelet rich plasma in arthroscopic rotator cuff repair: a prospective RCT study, 2-year follow-up. J Shoulder Elbow Surg, 2011, 20(4): 518-528.
8. Jo CH, Shin JS, Lee YG, et al. Platelet-rich plasma for arthroscopic repair of large to massive rotator cuff tears: a randomized, single-blind, parallel-group trial. Am J Sports Med, 2013, 41(10): 2240-2248.
9. Malavolta EA, Gracitelli ME, Ferreira Neto AA, et al. Platelet-rich plasma in rotator cuff repair: a prospective randomized study. Am J Sports Med, 2014, 42(10): 2446-2454.
10. Jo CH, Shin JS, Shin WH, et al. Platelet-rich plasma for arthroscopic repair of medium to large rotator cuff tears: a randomized controlled trial. Am J Sports Med, 2015, 43(9): 2102-2110.
11. 董佩龍, 唐曉波, 王健, 等. 自體富血小板血漿凝膠在關節鏡下肩袖修補術中的應用. 中華骨科雜志, 2015, 35(9): 942-947.
12. Flury M, Rickenbacher D, Schwyzer H, et al. Does pure platelet-rich plasma affect postoperative clinical outcomes after arthroscopic rotator cuff repair? A randomized controlled trial. Am J Sports Med, 2016, 44(8): 2136-2146.
13. Pandey V, Bandi A, Madi S, et al. Does application of moderately concentrated platelet-rich plasma improve clinical and structural outcome after arthroscopic repair of medium-sized to large rotator cuff tear? A randomized controlled trial. J Shoulder Elbow Surg, 2016, 25(8): 1312-1322.
14. Zhang ZX, Wang Y, Sun JY. The effect of platelet-rich plasma on arthroscopic double-row rotator cuff repair: a clinical study with 12-month follow-up. Acta Orthop Traumatol Turc, 2016, 50(2): 191-197.
15. Ebert JR, Wang A, Smith A, et al. A midterm evaluation of postoperative platelet-rich plasma injections on arthroscopic supraspinatus repair: a randomized controlled trial. Am J Sports Med, 2017, 45(13): 2965-2974.
16. Dohan Ehrenfest DM, Andia I, Zumstein MA, et al. Classification of platelet concentrates (platelet-rich plasma-PRP, platelet-rich fibrin-PRF) for topical and infiltrative use in orthopedic and sports medicine: current consensus, clinical implications and perspectives. Muscles Ligaments Tendons J, 2014, 4(1): 3-9.
17. 劉宇, 顧三軍, 徐耀增. 巨大肩袖損傷的診治現狀與進展. 中華創傷骨科雜志, 2018, 20(9): 823-828.
18. Martinelli D, Fornara P, Stecco A, et al. Does intraoperative platelet-rich plasma improve clinical and structural outcomes after arthroscopic repair of isolated tears of the supraspinatus tendon?. Indian J Orthop, 2019, 53(1): 77-81.

West China Medical Journal

Effects of platelet-rich plasma in arthroscopic full-thickness rotator cuff repair: a meta-analysis

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