Effects of Platelet-Rich Fibrin Matrix on Repair Integrity of At-Risk Rotator Cuff Tears

Abstract

Background: Increased age, larger tear size, and more advanced fatty degeneration of the rotator cuff musculature have been correlated with poorer healing rates after rotator cuff repair. Platelets are an endogenous source of growth factors present during rotator cuff healing.

Hypothesis: Augmentation of rotator cuff repairs with platelet-rich fibrin matrix (PRFM) may improve the biology of rotator cuff healing and thus improve functional outcome scores and retear rates after repair.

Study Design: Cohort study; Level of evidence, 3.

Methods: Rotator cuff tears at risk for retear were prospectively identified using an algorithm; points were assigned for age (50-59 years = 1; 60-69 years = 2; >70 years = 3), anterior-to-posterior tear size (2-2.9 cm = 0; 3-3.9 cm = 1; >4 cm = 2), and fatty atrophy (Goutallier score 0-2 = 0; Goutallier score 3-4 = 1). Three points were required for enrollment. Arthroscopic rotator cuff repair was performed with the addition of PRFM. Preoperative and 1-year postoperative magnetic resonance imaging (MRI) and functional outcome scores were obtained. Imaging and functional outcomes were compared with historical controls meeting the same enrollment criteria.

Results: Sixteen and 21 patients were enrolled in the PRFM and control groups, respectively. Mean age (65 ± 7 and 65 ± 9 years; P = .89), tear size (3.8 ± 1.1 and 3.9 ± 1.1 cm; P = .79), and median Goutallier scores (2 and 3; P = .18) were similar between the PRFM and control groups, respectively. Retear rates (56.2% vs 38.1%) were statistically significantly higher (P = .024) in the PRFM group compared with controls. Functional outcome scores postoperatively were not significantly improved compared with controls. Complications included 2 infections in the PRFM group.

Conclusion: The augmentation of at-risk rotator cuff tears with PRFM did not result in improved retear rates or functional outcome scores compared with controls.