PRP in Rotator Cuff

BEST EVIDENCE

Dr Htesh Gopalan U

Clinical Asst Professor, MOSCMM, Cochin

Editor, Orthopaedic Principles

Expert Advisor, OrthoEVIDENCE

2006

Allan Mishra,Founder, BOS, LA

Mishra A, Pavelko T. Treatment of chronic elbow tendinosis with buffered platelet-rich plasma. Am J Sports Med. 2006;34:1774- 1778.

Panacea?

Can it solve all?

•Head to Foot

•Different Pathology

•Healing with fibrosis

PRP in Shoulder

PRP in Rotator cuff

2 Scenarios

• Rotator cuff tendinitis/tendinosis

• Augmentation of rotator cuff repair

AJSM 2013

Kesikburun S et al.. [LEVEL 1]

• 40 Patients

•PRP Vs Placebo [US guided]

• Outcomes: WO Rotator cuff index, shoulder pain and disability index

• No difference at one yr follow up

Clin Rehabilitation 2013

Rha DW et al..[LEVEL 2]

• 39 patients

• PRP Vs Dry needling

• SPADI and ROM

• Significant difference only in flexion and internal rotation

AJSM 2013

Jo CH et al.. [LEVEL 2]

• 48 Patients :Arthroscopic cuff repair

• Retear rate using MRI, ASES Score, Constant score, SST, SPADI

• Retear rates : 4 Vs 10

• Functional outcome similar in both groups

PLoS One 2013

Zhang Q et al.. [LEVEL 1]

• PRP Augmentation in Arthroscopic repair

• 7 Studies : 6 RCT, 1 Prospective Cohort

• Constant score, ASES, UCLA

• Similar functional scores

• Decrease in retear rates in small to medium size tears

J Shoulder Elbow 2013

Randelli et al.. [LEVEL 1]

• 26 patients

• Arthroscopic augmentation with PRP and Autologous thrombin

• No difference in retear rates

• Higher functional scores

• Less retraction in grade 1 and 2 tears

J Shoulder Elbow 2014

Zumstein et al.. [LEVEL 2]

• 20 patients : Arthroscopic cuff repair

•Rotator cuff vascularity using ultra sound

•Rotator cuff quality using Sugaya classification

•Subjective shoulder value, Constant score, SST

•Results similar at 3 month follow up

AJSM 2013

Weber SC et al.. [LEVEL 2]

• PRFM : Arthroscopic augmentation

• 60 patients

• SST, ASES, UCLA, Retear rates

• No significant difference

• Less UCLA score in PRFM group - ? Detrimental

Arthroscopy 2013

Ruiz-Moneo P et al.. [LEVEL 2]

• 69 patients

• Arthroscopic augmentation with PRGF

• UCLA score, retear rates

• No significant difference

JBJS Am 2012

Gumina et al.. [LEVEL 2]

• 76 patients

• Arthroscopic augmentation with platelet leucocyte membrane

• Reduced retear rates

• No difference in Constant scores

Ortho Evidence Analysis

10 Trials = 578 patients

• ACE Reports

• Improvement in Constant scores only

• ASES, SPADI, UCLA scores : no difference

OrthoEvidence

Rotator cuff tendinitis/tendinosis

Evidence!!!

• PRP does not offer any benefit

PRP in Cuff repair Augmentation

7 Trials = 379 patients

• Decreased retear rates in small to medium sized tears

• Not useful in large tears

PRP in Cuff repair Augmentation

7 Trials = 379 patients

• Detrimental effect in 1 trial

Why the Difference ?

Different PRP Products

• Volume of blood

• Spin cycles

• centrifuge rates

• Activator

• WBC and Platelet Concentrations

CONCLUSION

• PRP beneficial for small to medium sized tears in augmentation following arthroscopic cuff repair

BUT…..