Platelet Concentration Does Not Influence Clinical Efficacy and Retear Rates of Rotator Cuff Repair With Platelet-Rich Plasma: A Systematic Review and Meta-analysis With Meta-Regression

Abstract

Background:

Platelet-rich plasma (PRP) is emerging as a popular augmentation technique in the context of rotator cuff repair (RCR) to strengthen the repair construct and promote healing. Previous studies examining the efficacy of PRP augmentation during RCR have described heterogeneous results.

Purpose:

To determine whether platelet concentration of a PRP injection as an adjunct of RCR impacts clinical outcomes and retear rates.

Study Design:

Systematic review and meta-analysis; Level of evidence, 2.

Methods:

A systematic review was performed by searching the PubMed, Cochrane Library, and Embase databases to identify level 1 and 2 studies that evaluated the clinical efficacy of RCR augmented with PRP. The search phrase used was “rotator cuff repair AND (PRP OR platelet rich plasma OR platelet-rich plasma).” Included randomized controlled trials were classified as utilizing high-dose or low-dose PRP based on their platelet concentration factor as a >4-fold increase over whole blood. The outcomes evaluated were the standardized mean differences of visual analog scale scores, Constant-Murley scores, American Shoulder and Elbow Surgeons scores, and University of California–Los Angeles scores, and pooled odds ratios of retear rates. Mixed-effects and random-effects meta-analyses were performed along with meta-regression to evaluate relationships in patient outcomes associated with PRP platelet dose.

Results:

Ten studies (level 1 or 2) met inclusion criteria, including 696 patients (346 PRP, 350 control). The mean patient age at the time of repair was 54.3 years, and the mean follow-up time was 25.7 months. Of the 10 studies, 6 utilized low-dose PRP and 4 utilized high-dose PRP. In both the meta-analysis and meta-regression analyses, there were no significant differences in mean postoperative scores for all patient-reported outcomes or in mean retear rates between platelet dosage groups (all P > .05).

Conclusion:

Platelet concentration may not influence the clinical outcomes and retear rates of patients undergoing RCR with PRP augmentation. Further studies that adequately report PRP procedures and composition regarding PRP as an RCR augmentation are necessary to achieve confidence in their clinical application and efficacy.