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Hovland S, Amin V, Liu J, Aceto M, Wright V. Perioperative Leukocyte-Poor Platelet-Rich Plasma Associated with Reduced Risk of Retear After Arthroscopic Rotator Cuff Repairs: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Arthroscopy 2025:S0749-8063(25)00370-6. [PMID: 40409437 DOI: 10.1016/j.arthro.2025.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2025] [Revised: 05/01/2025] [Accepted: 05/11/2025] [Indexed: 05/25/2025]
Abstract
PURPOSE To perform a systematic review and meta-analysis of randomized controlled trials (RCTs) in the literature to ascertain the clinical efficacy of leukocyte-poor platelet-rich plasma (LP-PRP) in arthroscopic rotator cuff repair. METHODS A through literature search was performed from databases such as PubMed, SCOPUS, Embase, Cochrane Library, and Google Scholar using keywords. Eligible studies must be randomized controlled trials with Level I or II evidence, ≥80% follow-up rate, at least 12 months of follow-up, use of leukocyte-poor PRP in arthroscopic rotator cuff repair, and report of postoperative outcomes. RESULTS Our literature search yielded nine randomized-controlled trials consisting of 743 patients, with 380 patients receiving LP-PRP and 363 patients receiving a control or placebo. Postoperative outcomes analyzed were rotator cuff retear rates, VAS Pain Scores, ASES Scores, UCLA Scores, and Constant Scores. Retear rates were significantly lower in the LP-PRP treated group compared to controls (RR = 0.54; CI: [0.41, 0.71]; P < 0.00001), VAS Pain scores were significantly lower in the LP-PRP treated group compared to controls (MD = -0.12; CI: [-0.24, -0.01]; P < 0.04), ASES scores were significantly higher in the LP-PRP treated group compared to controls (MD = 1.88; CI: [0.46, 3.31]; P < 0.01), Constant scores were significantly higher in the LP-PRP treated group compared to controls (MD = 2.58; CI: [1.28, 3.89]; P < 0.0001), and UCLA scores were significantly higher in the LP-PRP treated group compared to controls (MD = 1.16; CI: [0.17, 2.16]; P < 0.02). Retear rates showed a relative risk reduction of about 46% in patients who received LP-PRP compared to controls, and while VAS Pain Scores, ASES Scores, Constant Scores, and UCLA Scores all were significantly improved, these clinical outcomes scores did not meet the minimal clinical important difference established within the literature. CONCLUSION Administration of LP-PRP is associated with significantly reduced post-operative retear rates at minimum 12 months follow up compared to a saline injection control group. However, its use did not demonstrate clinically meaningful effects on postoperative pain or patient-reported outcomes, highlighting its primary benefit as enhancing structural healing. LEVEL OF EVIDENCE Systematic Review and meta-analysis,of Level I and II Studies.
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Affiliation(s)
- Samuel Hovland
- University of Central Florida College of Medicine, 6850 Lake Nona Blvd, Orlando, FL 32827, USA
| | - Vraj Amin
- University of Central Florida College of Medicine, 6850 Lake Nona Blvd, Orlando, FL 32827, USA.
| | - Jason Liu
- University of Central Florida College of Medicine, 6850 Lake Nona Blvd, Orlando, FL 32827, USA
| | - Matthew Aceto
- University of Central Florida College of Medicine, 6850 Lake Nona Blvd, Orlando, FL 32827, USA
| | - Vonda Wright
- University of Central Florida College of Medicine, 6850 Lake Nona Blvd, Orlando, FL 32827, USA; Hughston Orthopaedic Clinic Lake Nona, 6775 Chopra Ter, Orlando, FL 32827, USA
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Kim YK, Kim YT, Won YS, Jang YH, Hwang ST, Han J, Jeon S, Kim SH, Oh JH. Efficacy of an Autologous Dermal Fibroblast Injection in Reducing the Retear Rate After Arthroscopic Rotator Cuff Repair: A Prospective Randomized Controlled Trial. Am J Sports Med 2025; 53:592-599. [PMID: 39876067 DOI: 10.1177/03635465241311605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2025]
Abstract
BACKGROUND Interest in biological augmentation for improving bone-tendon interface (BTI) healing after arthroscopic rotator cuff repair (ARCR) is growing. Dermal fibroblasts, known for collagen synthesis similar to tenocytes, have shown effectiveness in BTI healing in chronic rotator cuff tear (RCT) models in rabbits. However, no human clinical trials have been conducted. PURPOSE To evaluate the clinical efficacy of autologous dermal fibroblasts (ADFs) for BTI healing after ARCR in patients with full-thickness RCTs >2 cm. STUDY DESIGN Randomized controlled trial; Level of evidence, 2. METHODS A total of 86 patients were prospectively enrolled and randomized into 2 groups: an additional ADF injection between the bone and tendon during ARCR (ADF group) or ARCR alone (control group). A skin biopsy from the buttock was performed to obtain ADFs, which were cultured for approximately 4 weeks before surgery. ARCR was standardized to the double-row suture bridge technique to reduce the heterogeneity in different repair methods. The primary variable for evaluating ADF efficacy was the retear rate using magnetic resonance imaging at 6 months postoperatively. Secondary variables included range of motion, the American Shoulder and Elbow Surgeons score, the Constant score, and the Simple Shoulder Test score at baseline and at 6 and 12 months postoperatively. RESULTS Overall, 13 patients dropped out because of a subscapularis tendon tear, loss to follow-up, or the withdrawal of consent (7 in the ADF group and 6 in the control group). The retear rate was significantly lower in the ADF group (5.6% [2/36]) than in the control group (24.3% [9/37]) (P = .025). The American Shoulder and Elbow Surgeons, Constant, and Simple Shoulder Test scores showed significant improvement after surgery in both groups (all P values <.001). Functional scores and range of motion did not significantly differ between the 2 groups at 6 and 12 months (all P values >.05). CONCLUSION ADF application into the BTI during ARCR significantly decreased the retear rate in patients with full-thickness RCTs >2 cm. Therefore, an ADF injection could be a promising biological supplement to enhance BTI healing in these patients. However, clinical outcomes showed no significant difference between the 2 groups at 6 months and 1 year postoperatively.
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Affiliation(s)
- Young Kyu Kim
- Department of Orthopaedic Surgery, Bundang Jesaeng Hospital, Seongnam, Republic of Korea
| | - Yong Tae Kim
- Department of Orthopedic Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea
| | - Yoo-Sun Won
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Young Hoon Jang
- Department of Orthopedic Surgery, Seoul One Hospital, Seoul, Republic of Korea
| | - Sun Tae Hwang
- Cutigen Research Institute, Tego Science, Seoul, Republic of Korea
| | - Jikhyon Han
- Cutigen Research Institute, Tego Science, Seoul, Republic of Korea
| | - Saewha Jeon
- Cutigen Research Institute, Tego Science, Seoul, Republic of Korea
| | - Sae Hoon Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Joo Han Oh
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
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Kotlier JL, Fathi A, Lin E, Freshman RD, Bolia IK, Liu JN, Petrigliano FA. Studies With Direct Industry Affiliation Are More Likely to Report Positive Results in Randomized Controlled Trials for Platelet-Rich Plasma Use in Rotator Cuff Tears: A Systematic Review. Arthroscopy 2025; 41:837-847. [PMID: 39214429 DOI: 10.1016/j.arthro.2024.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 07/18/2024] [Accepted: 08/18/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE To perform a systematic review to evaluate the effect of industry affiliation on the outcomes of randomized controlled trials for platelet-rich plasma (PRP) injections in rotator cuff tears METHODS: The PubMed, SPORTDiscus, and Scopus databases were searched from 2010 to the present for the terms "rotator cuff" and "platelet-rich plasma." The inclusion criteria were randomized controlled trials comparing PRP with controls for the treatment of rotator cuff tears, and the exclusion criteria were systematic reviews, meta-analyses, case reports, cohort studies, basic science studies, studies of Level III or below, and studies not in English. Degree of industry affiliation was categorized into 3 groups: directly, indirectly, and not affiliated. Direct affiliation required the study or its authors to receive financial support from the company manufacturing the devices used in the study to prepare or administer PRP. Indirect affiliation required financial association with a different company that produces or administers PRP than the company in the study. Studies were classified as favorable if study outcomes achieved significance (P < .05) of PRP over controls or as analogous if there was no statistical significance between PRP and controls. Data were analyzed using the χ2 test and Fisher exact test. RESULTS Of the 47 studies selected for analysis, 8 (17.0%) had no direct industry affiliation; 9 (19.1%) had indirect affiliation; and 30 (63.8%) had no industry affiliation. Of the studies, 22 (46.8%) reported favorable results with PRP compared with controls and 25 (53.2%) showed analogous results between PRP and controls. Degree of industry affiliation was significantly associated with an increased likelihood of reporting favorable study outcomes (P = .041). Directly affiliated studies had a significantly increased likelihood of reporting favorable results (P = .024) compared with indirectly affiliated studies. CONCLUSIONS Studies that used PRP produced by companies that directly funded the studies or were financially affiliated with the authors were significantly more likely to report favorable results. LEVEL OF EVIDENCE Level II, systematic review of Level I and II studies.
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Affiliation(s)
- Jacob L Kotlier
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California, U.S.A..
| | - Amir Fathi
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California, U.S.A
| | - Eric Lin
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California, U.S.A
| | - Ryan D Freshman
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California, U.S.A
| | - Ioanna K Bolia
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California, U.S.A
| | - Joseph N Liu
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California, U.S.A
| | - Frank A Petrigliano
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California, U.S.A
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Azharuddin S, Gahlot N, Elhence A, Garg P, Mandal S, Saxena S. Improved healing and functional outcome is seen at 12 months after injecting leukocyte rich-PRP in arthroscopically repaired labrum: A case-control study. Shoulder Elbow 2025:17585732251319259. [PMID: 40007628 PMCID: PMC11848860 DOI: 10.1177/17585732251319259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2024] [Revised: 01/04/2025] [Accepted: 01/23/2025] [Indexed: 02/27/2025]
Abstract
Introduction A study with the hypothesis: platelet-rich plasma (PRP) injection into labrum repair will produce better healing response and improved functional outcome in patients of recurrent shoulder dislocation treated with arthroscopic Bankart repair. Methods Arthroscopically repaired recurrent shoulder dislocation patients. Group 1 (cases): administered LR-PRP injection. Group 2 (controls): not received PRP injection. The injection was given arthroscopically at the labrum-bone interface after repair was completed. Results A total of 40 patients: 20 in group I (cases) and 20 in group II (controls). The mean age was 26 ± 6 years; 36 patients (90%) were male and 4 patients (10%) were female. All three scores showed improvement at follow-up evaluation inside the groups (P < .001). Individual score improvement was more in group I, the difference was statistically significant for the American Shoulder and Elbow Surgeon (ASES) and Disabilities of the Arm, Shoulder and Hand (DASH) scores (P < .05). The CSS was also higher in group I (93.2 ± 2.8) at follow-up as compared to group II (91.5 ± 2.7, P = .063). Follow-up magnetic resonance imaging (MRI) evaluation showed improvement in labral height (P < .05), Labrum height glenoid index (P > .05), and Labral slope (P < .05) in both the groups, the increase was more in group I as compared to group II. Conclusion PRP injection at the labrum-bone interface provides a better healing response in the labrum and better functional outcomes at 12 months after arthroscopic bankart repair. Level of evidence Level III, case-control study.
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Affiliation(s)
- Sheikh Azharuddin
- Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Nitesh Gahlot
- Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Abhay Elhence
- Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Pawan Garg
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Saptarshi Mandal
- Department of Transfusion Medicine and Blood Bank, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Suvinay Saxena
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
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Nieminen A, Nurminen J, Aavikko A, Puhakka J, Haapala J, Keemu H, Kukkonen J, Alho A, Uusalo P, Mäkelä K, Kosola J. Platelet-rich plasma does not influence magnetic resonance imaging findings of the gluteus muscles after total hip arthroplasty through the Hardinge approach. Skeletal Radiol 2025:10.1007/s00256-025-04876-8. [PMID: 39870845 DOI: 10.1007/s00256-025-04876-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Revised: 01/14/2025] [Accepted: 01/15/2025] [Indexed: 01/29/2025]
Abstract
OBJECTIVE Total hip arthroplasty through the Hardinge approach damages the hip abductor muscles. MRI can be used to assess adverse postoperative events. In this prospective randomized controlled trial, we evaluated MRI findings and whether platelet-rich plasma affected postoperative healing of the gluteal muscles (gluteus medius and minimus). MATERIALS AND METHODS Forty patients with hip osteoarthritis requiring treatment with total hip arthroplasty, aged between 60 and 76 years, were included. Patients were randomized into two groups: 19 patients in the platelet-rich plasma group and 21 in the placebo group. Platelet-rich plasma or placebo was injected into the gluteus medius tendon incision line during closure. Postoperative hip MRI and plain radiographs were taken 3 and 12 months after surgery. RESULTS MRI showed fatty atrophy of the gluteal muscles in all 40 patients (100%), gluteal muscle tear in 11 patients (28%), and atrophy in 16 patients (40%) at both 3 and 12 months postoperatively. Fluid collections related to the operated hip joint were seen in 18 patients (45%) at 3 months and 13 patients (33%) at 12 months, heterotopic ossification formation in nine patients (23%) at 3 months, and 12 patients (31%) at 12 months. There were no significant differences in imaging findings between the two groups. CONCLUSION MRI can be a valuable tool for evaluating postoperative healing after total hip arthroplasty. Fatty atrophy of the gluteal muscles was a common finding. Platelet-rich plasma injection into the gluteus medius tendon did not improve healing detected by MRI.
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Affiliation(s)
- Anette Nieminen
- Department of Orthopedics and Traumatology, Turku University Hospital, University of Turku, Luolavuorentie 2, 20700, Turku, Finland.
| | - Janne Nurminen
- Department of Radiology, Turku University Hospital, University of Turku, Turku, Finland
| | - Anni Aavikko
- Department of Orthopedics and Traumatology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Jani Puhakka
- Department of Orthopedics and Traumatology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Jussi Haapala
- Department of Orthopedics and Traumatology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Hannes Keemu
- Department of Orthopedics and Traumatology, Turku University Hospital, University of Turku, Luolavuorentie 2, 20700, Turku, Finland
| | - Juha Kukkonen
- Department of Surgery, Satakunta Central Hospital, Pori, Finland
| | - Ari Alho
- Department of Anaesthesiology and Intensive Care, University of Turku, Turku, Finland
- Division of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland
| | - Panu Uusalo
- Department of Anaesthesiology and Intensive Care, University of Turku, Turku, Finland
- Division of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland
| | - Keijo Mäkelä
- Department of Orthopedics and Traumatology, Turku University Hospital, University of Turku, Luolavuorentie 2, 20700, Turku, Finland
| | - Jussi Kosola
- Department of Orthopedics and Traumatology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Department of Orthopedics and Traumatology, Kanta-Häme Central Hospital, Hämeenlinna, Finland
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Abesteh J, Al-Asadi M, Abdel Khalik H, Dagher D, Madden K, Bedi A, Khan M. The continuous fragility index of outcomes in rotator cuff repair augmentation randomized trials: a systematic review. J Shoulder Elbow Surg 2024:S1058-2746(24)00959-5. [PMID: 39742947 DOI: 10.1016/j.jse.2024.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 10/22/2024] [Accepted: 11/03/2024] [Indexed: 01/04/2025]
Abstract
BACKGROUND Symptomatic rotator cuff tears often undergo surgical repair, which may be paired with various augmentation strategies to enhance structural healing rates. While many randomized controlled trials (RCTs) evaluate augmentation techniques, the statistical robustness of many findings in these studies is unknown. This systematic review aims to evaluate the continuous fragility index (CFI) of RCTs on augmentation techniques for rotator cuff repairs. METHODS MEDLINE, Embase, and CENTRAL databases were comprehensively searched from inception to September 2023 for RCTs assessing the efficacy of at least 1 augmentation strategy during rotator cuff repair. Eligible studies reported at least 1 statistically significant finding for a continuous outcome. The CFI for eligible outcomes was calculated, with median CFI presented by type of augmentation and outcome. Multivariable regression was performed to identify associations between CFI and other outcome variables. RESULTS Nineteen RCTs (1305 patients) were included in the final analysis. The median CFI for the 86 outcomes analyzed was 5.85 (interquartile range [IQR]: 2.3-14.4). Augmentation-specific analysis demonstrated variability in CFIs, with the most robust outcomes found in platelet-rich plasma studies (median: 10.95; IQR: 3.3-19.0) and suture-spanning augmentation studies (median: 11.90; IQR: 11.45-14.35). Outcome-specific analysis demonstrated range of motion outcomes as most robust (median: 9.85; IQR: 7.58-14.0) and strength-related outcomes as most fragile (median: 2.00; IQR: 1.0-16.3). Multivariable regression identified larger sample size as a statistically significant predictor of greater CFI. Notably, loss to follow-up exceeded the CFI in 31.4% of outcomes. CONCLUSION The observed median CFI of 5.85 in augmentation trials is consistent with the CFI reported in orthopedic and sports medicine literature. However, almost a third of outcomes had a loss to follow-up exceeding their CFI, risking the reversal of study findings with more robust follow-up and outcomes. Clinicians and researchers should consider fragility in addition to P values when assessing study results, especially in the context of high loss to follow-up. Future trials should report the fragility of their findings.
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Affiliation(s)
- James Abesteh
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Mohammed Al-Asadi
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Hassaan Abdel Khalik
- Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Danielle Dagher
- Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Kim Madden
- Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | | | - Moin Khan
- Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
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Warren JR, Domingo-Johnson ER, Sorensen AA, Cheng AL, Latz KH, Cil A. Bioinductive patch as an augmentation for rotator cuff repair, a systematic review and meta-analysis. J Shoulder Elbow Surg 2024; 33:2515-2529. [PMID: 38942225 DOI: 10.1016/j.jse.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 04/17/2024] [Accepted: 05/04/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND Rotator cuff tears are a prevalent cause of shoulder pain and dysfunction. For those who fail initial conservative treatment, operative intervention can be pursued. A significant and common complication after rotator cuff repair (RCR) is retearing or nonhealing. Numerous augmentations to traditional suture RCR have been studied. Of these, the Smith + Nephew Regeneten bioinductive collagen patch has had promising initial results; however, analytic data for its use are lacking, and there is no meta-analysis comparing the available data to historical RCR outcomes. METHODS A PRISMA-guided literature search was conducted using Ovid MEDLINE, PubMED, Cochrane, and ClinicalTrials.gov. Thirteen studies met inclusion and exclusion criteria. Only clinical trials on full and partial-thickness tears were included. American Shoulder and Elbow Surgeon score, Constant-Murley Score, the visual analog scale for pain, the minimal clinically important difference (MCID), tendon thickness, and complication rates were primary outcomes of interest. A meta-analysis was performed to determine the overall complication and retear rate from the included studies. RESULTS American Shoulder and Elbow Surgeon score, Constant-Murley Score, and visual analog scale for pain improved significantly in all studies that reported them, and most patients achieved MCID. Patient-reported outcome measure improvements were similar to historical improvements in standard RCR, and a similar proportion of patients achieved MCID after standard repair. Tendon thickness improved significantly and to a similar degree as standard RCR. Overall retear rate after full thickness RCR augmented with the bioinductive patch was 8.3%. For partial thickness RCR, total retear rate was of 1.1% across all patients. The overall complication rate with the bioinductive patch was 15.5% across all full-thickness RCR studies and 16.2% in partial thickness RCR. We found overall retear rate to be lower after augmentation with the bioinductive patch compared to traditional repair; however, the overall complication rate was similar for full-thickness tears and higher for partial-thickness tears. Lastly, adverse reactions to the bioinductive patch were noted at 0.2%. CONCLUSIONS The bioinductive collagen patch appears to be a safe augmentation for rotator cuff repair. Patients are likely to experience significant subjective improvement in patient-reported outcome measures and significant increases in tendon thickness. Retear rate has been a concern after RCR for decades, and the bioinductive patch may help mitigate this risk. There is lack of case-control studies comparing the bioinductive patch to traditional suture RCR. Such data are needed to better determine the role of the bioinductive patch in the treatment of full and partial-thickness rotator cuff repairs.
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Affiliation(s)
- Jonathan R Warren
- Department of Orthopedic Surgery, University of Missouri Kansas City, Kansas City, MO, USA.
| | - El R Domingo-Johnson
- Department of Orthopedic Surgery, University of Missouri Kansas City, Kansas City, MO, USA
| | - Amelia A Sorensen
- Department of Orthopedic Surgery, University of Missouri Kansas City, Kansas City, MO, USA
| | - An-Lin Cheng
- Department of Orthopedic Surgery, University of Missouri Kansas City, Kansas City, MO, USA
| | - Kevin H Latz
- Department of Orthopedic Surgery, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Akin Cil
- Department of Orthopedic Surgery, University of Missouri Kansas City, Kansas City, MO, USA
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Camarena A, Kang L, Mirando AJ, Augustine E, McMillian NS, Stinson NC, Agarwal SM, Becker ML, Hilton MJ, Fernandez-Moure JS. Platelet-rich plasma enhances rib fracture strength and callus formation in vivo. J Trauma Acute Care Surg 2024:01586154-990000000-00796. [PMID: 39238099 DOI: 10.1097/ta.0000000000004441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2024]
Abstract
BACKGROUND Rib fractures are a common traumatic injury affecting more than 350,000 patients a year. Early stabilization has shown to be effective in reducing pulmonary complications. Platelet-rich plasma (PRP) is a growth factor-rich blood product known to improve soft tissue and bone healing. We hypothesized that the addition of PRP to a rib fracture site would accelerate callus formation and improve callus strength. METHODS Platelet-rich plasma was isolated from pooled Lewis rat blood and quantified. Thirty-two Lewis rats underwent fracture of the sixth rib and were treated with 100 μL PRP (1 × 106 platelets/μL) or saline. At 2 weeks, ribs were harvested and underwent a 3-point bend, x-ray, and microcomputed tomography, and callus sections were stained with 4',6-diamidino-2-phenylindole and Alcian blue and picrosirius red. At 6 weeks, ribs were harvested and underwent a 3-point bend test, x-ray, microcomputed tomography, and Alcian blue and picrosirius red staining. RESULTS At 2 weeks, PRP increased callus diameter (9.3 mm vs. 4.3 mm, p = 0.0002), callus index (4.5 vs. 2.1, p = 0.0002), bone volume/total volume (0.0551 vs. 0.0361, p = 0.0024), cellularization (2,364 vs. 1,196, p < 0.0001), and cartilage (12.12% vs. 3.11%, p = 0.0001) and collagen (6.64% vs. 4.85%, p = 0.0087) content compared with controls. At 6 weeks, PRP increased fracture callus diameter (5.0 mm vs. 4.0 mm, 0.0466), callus index (2.5 vs. 2.0, p = 0.0466), BV/TV (0.0415 vs. 0.0308, p = 0.0358), and higher cartilage (8.21% vs. 3.26%, p < 0.0001) and collagen (37.61% vs. 28.00%, p = 0.0022) content compared with controls. At 6 weeks, PRP samples trended toward improved mechanical characteristics; however, these results did not reach significance (p > 0.05). CONCLUSION Rib fractures are a common injury, and accelerated stabilization could improve clinical outcomes. Platelet-rich plasma significantly increased callus size, calcium deposition, and cartilage and collagen content at 2 and 6 weeks and trended toward improved strength and toughness on mechanical analysis at 6 weeks compared with controls, although this did not reach significance. These findings suggest that PRP may be a useful adjunct to accelerate and improve fracture healing in high-risk patients.
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Affiliation(s)
- Adrian Camarena
- From the Department of Surgery (A.C., L.K., S.M.A., J.S.F.-M.), Duke University Medical Center; Department of Orthopedic Surgery (A.J.M., M.J.H.), Duke University School of Medicine; Division of Trauma, Acute, and Critical Care Surgery (N.S.M., S.M.A., J.S.F.-M.), Duke University Medical Center; and Department of Chemistry (E.A., N.C.S., M.L.B.), Department of Mechanical Engineering and Materials Science (E.A., N.C.S., M.L.B.), Department of Biomedical Engineering (E.A., N.C.S., M.L.B.), Department of Orthopedic Surgery (E.A., N.C.S., M.L.B.), and Department of Cell Biology (M.J.H.), Duke University, Durham, North Carolina
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Odložilová Š, Paral J, Sirovy M, Zajak J, Fibír A. Platelet-Rich Plasma: Characteristics and Current Review of its Use in Surgery. POLISH JOURNAL OF SURGERY 2024; 96:66-74. [PMID: 39465631 DOI: 10.5604/01.3001.0054.6750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2024]
Abstract
Platelet-rich plasma (PRP) is presently employed across various medical disciplines, including surgical specialties. It is primarily used in the healing of chronic wounds, burn medicine, tissue regeneration support, and scar correction as well as in other surgical and orthopedic indications. Wounds, in general, possess a pro-inflammatory biochemical environment characterized by high protease activity that diminishes the effective concentration of growth factors. In contrast, PRP serves as a source of growth factors and exhibits mitogenic, angiogenic, and chemotactic properties. PRP is a biological product defined as a portion of the autologous blood's plasma fraction with a higher than physiological platelet concentration. PRP is obtained through the centrifugation of blood samples collected from patients. The insights into the biology, mechanism of action, and classification of PRP presented in this review can assist medical professionals in orienting themselves and comprehending the possibilities of the clinical application of this therapy, which remains a subject of investigation and validation. This review summarizes up-to-date information regarding the use of PRP, primarily in burn and reconstructive surgery, plastic surgery, traumatology, and general surgery.
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Affiliation(s)
- Šárka Odložilová
- Department of Military Surgery, Military Faculty of Medicine, University of Defence, Hradec Kralove, Czech Republic, Department of Surgery, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Jiri Paral
- Department of Military Surgery, Military Faculty of Medicine, University of Defence, Hradec Kralove, Czech Republic, Department of Surgery, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic, Department of Surgery, Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Miroslav Sirovy
- Department of Military Surgery, Military Faculty of Medicine, University of Defence, Hradec Kralove, Czech Republic, Department of Surgery, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Jan Zajak
- Department of Military Surgery, Military Faculty of Medicine, University of Defence, Hradec Kralove, Czech Republic, Department of Surgery, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Aleš Fibír
- Department of Surgery, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic, Department of Surgery, Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
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Shen Z, Ye X, He Y, Shen G, Xu K, Zhang B, Wu L. Arthroscopic rotator cuff repair combined with platelet-rich plasma products can reduce the rate of retearing and improve clinical outcomes: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2024; 103:e38069. [PMID: 38701265 PMCID: PMC11062711 DOI: 10.1097/md.0000000000038069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 04/10/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Although several studies on the potential benefits of protein-rich plasma (PRP) therapy for rotator cuff injuries have been published, the results have been conflicting. Therefore, this study aimed to determine whether PRP is beneficial for the prevention of retears after arthroscopic rotator cuff repair (ARCR). METHODS Two reviewers conducted independent literature searches based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomized controlled trials (RCTs) comparing a PRP treatment group with a control group were included. The quality of evidence was assessed using the Cochrane Collaboration Risk of Bias Tool. Clinical outcomes were compared using the risk ratio (RR) for dichotomous variables and weighted mean difference (WMD) for continuous variables. Statistical significance was set at P < .05. RESULTS This review included 21 RCTs (1359 patients). Significant results were noted in favor of PRP treatment compared with controls based on retearing rates (16.5% vs 23.6%, respectively; P = .002) and the Constant score in the short term (WMD: 1.98; 95% confidence interval [CI], 0.27-3.70; I2 = 0%; P = .02), medium term and long term (WMD: 2.56 [95% CI: 1.57-3.55]; I2 = 2%; P < .001); the University of California, Los Angeles score in the short term (WMD: 1.14 [95% CI: 0.43-1.85]; I2 = 25%; P = .002) but not in the medium and long term (WMD: 0.66 [95% CI: -0.16 to 1.48]; I2 = 57%; P = .11); and the visual analog scale score in the short term (WMD: -0.63 [95% CI: -0.83 to-0.43]; I2 = 41%; P < .001), medium and long term (WMD: -0.12 [95% CI: -0.19 to-0.05]; I2 = 0%; P = .008). There was no significant difference in American Shoulder and Elbow Surgeons scores between the treatment and control groups in the short term (WMD: -0.48 [95% CI: -2.80 to 1.85]; I2 = 22%; P = .69) or medium and long term (WMD: 0.92 [95% CI: -1.56 to 3.39]; I2 = 40%; P = .47). CONCLUSION Intraoperative use of PRP reduces the risk of rotator cuff repair failure, improves clinical outcomes, and reduces recurrence rates.
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Affiliation(s)
- Zhe Shen
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Xiaoang Ye
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Yawen He
- Hangzhou Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Gaobo Shen
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Kuangying Xu
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Bingbing Zhang
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Lianguo Wu
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
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Rossi LA, Gorodischer TD, Camino P, Brandariz RN, Tanoira I, Piuzzi NS, Ranalletta M. Leukocyte-Poor Platelet-Rich Plasma as an Adjuvant to Arthroscopic Rotator Cuff Repair Reduces the Retear Rate But Does Not Improve Functional Outcomes: A Double-Blind Randomized Controlled Trial. Am J Sports Med 2024; 52:1403-1410. [PMID: 38587033 DOI: 10.1177/03635465241239062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
BACKGROUND Whether the use of PRP as an adjuvant of rotator cuff repairs leads to improved tendon healing and better functional outcomes remains unclear in clinical evidence. PURPOSE The main purpose of this study was to assess whether the use of leukocyte-poor platelet-rich plasma (LP-PRP) as an adjuvant to arthroscopic rotator cuff repair (ARCR) decreases the rate of retears compared with a control group. The secondary objective was to analyze whether LP-PRP improves patient-reported outcomes. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS This was a double-blind randomized controlled trial at a single center. A consecutive series of 96 patients with rotator cuff tears <3 cm were enrolled and randomly allocated to the control group (double-row suture-bridge ARCR alone [n = 48]) and the PRP group (double-row suture-bridge repair, followed by 1 LP-PRP injection during surgery [n = 48]). The visual analog scale (VAS) for pain, the American Shoulder and Elbow Surgeons (ASES) score, the Single Assessment Numeric Evaluation (SANE), and the Pittsburgh Sleep Quality Index (PSQI) were administered preoperatively and at 6- and 12-month follow-up. Magnetic resonance imaging (MRI) was performed to evaluate tendon integrity at 6-month follow-up. Both patients and assessors were blinded to the intervention received during surgery. RESULTS The mean patient age was 56.1 ± 2.98 years. Of the 96 patients, 90 had MRI performed at 6 months after surgery (94% radiological follow-up). The retear rate in the PRP group was 15.2% (7/46 [95% CI, 6%-28%]), which was lower than that in the control group of 34.1% (15/44 [95% CI, 20%-49%]) (P = .037). Therefore, the risk ratio of ruptures in patients exposed to LP-PRP was 0.44 (95% CI, 0.2-0.9; P = .037). Overall, the ASES, VAS, SANE, and PSQI scores showed a statistical improvement after surgery (P < .001). There were no significant differences in functional scores between the groups. Most of the patients exceeded the minimal clinically important difference for the ASES, SANE, and VAS without significant differences between the groups. CONCLUSION In patients with rotator cuff tears <3 cm undergoing double-row suture-bridge repair, a 5-mL dose of LP-PRP injected at the tendon-bone interface significantly reduced the retear rate. However, the use of LP-PRP in terms of postoperative pain and patient-reported outcomes failed to show clinically meaningful effects. REGISTRATION NCT04703998 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Luciano Andres Rossi
- "Carlos E. Ottolenghi" Instituto de Ortopedia y Traumatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Tomás David Gorodischer
- "Carlos E. Ottolenghi" Instituto de Ortopedia y Traumatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Pablo Camino
- Department of Hemotherapy, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Rodrigo Nicolás Brandariz
- "Carlos E. Ottolenghi" Instituto de Ortopedia y Traumatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ignacio Tanoira
- "Carlos E. Ottolenghi" Instituto de Ortopedia y Traumatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Nicolás Santiago Piuzzi
- Department of Hemotherapy, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Maximiliano Ranalletta
- "Carlos E. Ottolenghi" Instituto de Ortopedia y Traumatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Sánchez-Losilla C, Ferré-Aniorte A, Álvarez-Díaz P, Barastegui-Fernández D, Cugat R, Alentorn-Geli E. Efficacy of platelet-rich plasma in rotator cuff repair: systematic review and meta-analysis. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:296-305. [PMID: 37270058 DOI: 10.1016/j.recot.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 05/17/2023] [Accepted: 05/30/2023] [Indexed: 06/05/2023] Open
Abstract
OBJECTIVE To analyze the efficacy and safety after the application of platelet-rich-plasma (PRP) as an adjuvant in arthroscopic rotator cuff repairs. MATERIAL AND METHODS A bibliographic search of the literature of prospective studies with level of evidence one or two was carried out from January 2004 to December 2021, including studies that compare the functional and re-tear results after arthroscopic cuff repair rotator with or without PRP. RESULTS A total of 281 articles were identified, of which 14 met the inclusion criteria. The overall re-rupture rate was 24%. In the PRP group, a decrease in the re-rupture rate and better functional results were demonstrated, although these differences were not significant. CONCLUSIONS Adjuvant treatment with PRP has shown promising results, although there is not yet enough evidence to provide a clear advantage for routine use in clinical practice.
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Affiliation(s)
| | - A Ferré-Aniorte
- Instituto Cugat, Barcelona, España; Fundación García-Cugat, Barcelona, España
| | - P Álvarez-Díaz
- Instituto Cugat, Barcelona, España; Mutualidad de Futbolistas, Federación Española de Fútbol - Delegación Cataluña, Barcelona, España; Fundación García-Cugat, Barcelona, España
| | - D Barastegui-Fernández
- Mutualidad de Futbolistas, Federación Española de Fútbol - Delegación Cataluña, Barcelona, España
| | - R Cugat
- Instituto Cugat, Barcelona, España; Mutualidad de Futbolistas, Federación Española de Fútbol - Delegación Cataluña, Barcelona, España; Fundación García-Cugat, Barcelona, España
| | - E Alentorn-Geli
- Instituto Cugat, Barcelona, España; Mutualidad de Futbolistas, Federación Española de Fútbol - Delegación Cataluña, Barcelona, España; Fundación García-Cugat, Barcelona, España
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Sánchez-Losilla C, Ferré-Aniorte A, Álvarez-Díaz P, Barastegui-Fernández D, Cugat R, Alentorn-Geli E. [Translated article] Efficacy of platelet-rich plasma in rotator cuff repair: Systematic review and meta-analysis. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:T296-T305. [PMID: 38232930 DOI: 10.1016/j.recot.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/30/2023] [Indexed: 01/19/2024] Open
Abstract
OBJECTIVE To analyse the efficacy and safety after the application of platelet-rich-plasma (PRP) as an adjuvant in arthroscopic rotator cuff repairs. MATERIAL AND METHODS A bibliographic search of the literature of prospective studies with level of evidence one or two was carried out from January 2004 to December 2021, including studies that compare the functional and re-tear results after arthroscopic cuff repair rotator with or without PRP. RESULTS A total of 281 articles were identified, of which 14 met the inclusion criteria. The overall re-rupture rate was 24%. In the PRP group, a decrease in the re-rupture rate and better functional results were demonstrated, although these differences were not significant. CONCLUSIONS Adjuvant treatment with PRP has shown promising results, although there is not yet enough evidence to provide a clear advantage for routine use in clinical practice.
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Affiliation(s)
| | - A Ferré-Aniorte
- Instituto Cugat, Barcelona, Spain; Fundación García-Cugat, Barcelona, Spain
| | - P Álvarez-Díaz
- Instituto Cugat, Barcelona, Spain; Mutualidad de Futbolistas, Federación Española de Fútbol - Delegación Cataluña, Barcelona, Spain; Fundación García-Cugat, Barcelona, Spain
| | - D Barastegui-Fernández
- Mutualidad de Futbolistas, Federación Española de Fútbol - Delegación Cataluña, Barcelona, Spain
| | - R Cugat
- Instituto Cugat, Barcelona, Spain; Mutualidad de Futbolistas, Federación Española de Fútbol - Delegación Cataluña, Barcelona, Spain; Fundación García-Cugat, Barcelona, Spain
| | - E Alentorn-Geli
- Instituto Cugat, Barcelona, Spain; Mutualidad de Futbolistas, Federación Española de Fútbol - Delegación Cataluña, Barcelona, Spain; Fundación García-Cugat, Barcelona, Spain
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Nunes B, Martins R, Linhares D, Azevedo L, Canadas R, Gutierres M. Effect of Platelet-Rich Plasma Dosing for Healing after Arthroscopic Cuff Repair Compared with Surgery Alone: A Systematic Review and Meta-Analysis. Med Sci Sports Exerc 2024; 56:796-804. [PMID: 38480490 DOI: 10.1249/mss.0000000000003361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
INTRODUCTION Platelet-rich plasma (PRP) has been used for arthroscopic rotator cuff repairs (aRCR), but no studies have addressed the impact of platelet concentration. The primary aim was to evaluate whether the PRP cell concentration has an effect on tendon healing after aRCR compared with surgery alone. The secondary aim was to assess the functional and pain outcomes. MATERIALS AND METHODS A systematic review was performed with searches in the MEDLINE (PubMed), Scopus, Web of Science, and Cochrane (Central) databases according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Metanalytic procedures were performed for randomized controlled trials (RCTs), and a subgroup analysis was used for studies with target (approximately 10 6 cells·μL -1 ) or below-target PRP cellular concentrations (app. 5 × 10 5 cells·μL -1 ) regarding the primary outcome of tendon healing. RESULTS This review included 10 studies (8 RCTs) with 342 patients in the aRCR + PRP group and 344 patients with isolated aRCR. The risk of bias was low to intermediate (6/4, respectively). Meta-analysis of the RCT revealed that the aRCR + high-concentration PRP group had an approximately 3.9-fold higher chance of healing than the non-PRP group (odds ratio, 3.89; 95% confidence interval, 1.78-8.44; P = 0.0007). No significant difference in healing was found between the aRCR + low-concentration PRP and non-PRP groups (odds ratio, 2.21; 95% confidence interval, 0.66-7.45; P = 0.2). The Constant-Murley score and University of California Los Angeles scores were significantly improved in the aRCR + PRP groups with more than 12 months of follow-up, and no significant differences were found consistently for the American Shoulder and Elbow Society and visual analog scale scores. CONCLUSIONS This study highlights that a PRP cell concentration close to the target (10 6 cells·μL -1 ) of patients with aRCR may improve their healing and functional outcomes and that dosing may be potentially useful in therapy.
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Affiliation(s)
| | - Ricardo Martins
- Faculty of Medicine of the University of Porto, Porto, PORTUGAL
| | | | - Luís Azevedo
- CINTESIS@RISE-Center for Health Technology and Services Research at the Health Research Network, MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine of the University of Porto, Porto, PORTUGAL
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Hill M, Allen C, Williamson TK, Martinez V, Vangeli S, Zaheer A, Kingery MT, Checketts JX. Top 50 most impactful publications on massive rotator cuff tears. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:20-32. [PMID: 38323204 PMCID: PMC10840572 DOI: 10.1016/j.xrrt.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Background Bibliometric analysis is a useful tool for measuring the scholarly impact of a topic and its more and less heavily studied aspects. The purpose of this study is to use bibliometric analysis to comprehensively analyze the 50 articles with the highest citation indices in studies evaluating the treatment and outcomes of massive rotator cuff tears (mRCTs). Methods This cross-sectional study identified articles within the Scopus database published through December 2022. Keywords used were "massive rotator cuff tear." Articles were sorted in chronological order. The year published and number of citations were recorded. A citation index (CI) was calculated for each article by dividing the number of citations by number of years published [1 citation/1 year published (2021) = CI of 1]. Of these, the 50 articles with the highest CIs were carried forward for evaluation. Frequencies and distributions were assessed for data of each variable collected. Results These search methods produced 625 articles regarding mRCT research (ranging from January 1986 to December 2022). Four of the top 10 most impactful articles were published in the 2010s. The level of evidence (LOE) published with the greatest frequency was level of evidence 4 (41%). The journal Arthroscopy published the highest number within the top 50 (26%) followed by the Journal of Bone and Joint Surgery and the American Journal of Sports Medicine (20% each). Clinical studies composed 88% of the top 50. Case series (38%) predominated, while systematic reviews (20%) and randomized control trials (8%) were less prevalent. The majority of studies concentrated on the clinical outcomes of certain interventions (62%), mainly comparing multiple interventions. Conclusion Despite the relatively high prevalence of mRCTs (40% of all tears), this topic comprises only a small proportion of all rotator cuff research. This analysis has identified gaps within and limitations of the findings concerning mRCTs for researchers to propose research questions targeting understudied topics and influence the future treatment and outcomes of this clinically difficult diagnosis.
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Affiliation(s)
- Marcheta Hill
- University of the Incarnate Word School of Osteopathic Medicine, San Antonio, TX, USA
| | - Christian Allen
- University of the Incarnate Word School of Osteopathic Medicine, San Antonio, TX, USA
| | - Tyler K. Williamson
- Department of Orthopaedic Surgery, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Victor Martinez
- University of the Incarnate Word School of Osteopathic Medicine, San Antonio, TX, USA
| | - Sydney Vangeli
- University of the Incarnate Word School of Osteopathic Medicine, San Antonio, TX, USA
| | - Aroob Zaheer
- University of the Incarnate Word School of Osteopathic Medicine, San Antonio, TX, USA
| | - Matthew T. Kingery
- Department of Orthopaedic Surgery, NYU Langone Medical Center, New York, NY, USA
| | - Jake X. Checketts
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, OK, USA
- St Francis Medical Center, Tulsa, OK, USA
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Aghajanova L, Zhang A, Lathi RB, Huddleston HG. Platelet-rich plasma infusion as an adjunct treatment for persistent thin lining in frozen embryo transfer cycles: first US experience report. J Assist Reprod Genet 2024; 41:483-491. [PMID: 37996549 PMCID: PMC10894781 DOI: 10.1007/s10815-023-02993-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/16/2023] [Indexed: 11/25/2023] Open
Abstract
PURPOSE To study effect of intrauterine infusion of platelet-rich plasma (PRP) on endometrial growth in the setting of thin endometrial lining in patients with prior cancelled or failed frozen embryo transfer (FET) cycles. MATERIALS AND METHODS Single-arm cohort study of forty-six patients (51 cycles) with endometrial lining thickness (EMT) < 6 mm in prior cancelled or failed FET cycles requesting intrauterine PRP treatment in upcoming FET cycle. The primary outcomes were final EMT in FET cycle and change in EMT after PRP. The secondary outcomes were overall pregnancy rate, clinical pregnancy rate, miscarriage rate, ongoing pregnancy, and live birth rates. RESULTS The mean pre-PRP EMT in all FET cycles was 4.0 ± 1.1 mm, and mean post-PRP EMT (final) was 7.1 ± 1.0 mm. Of 51 cycles, 33 (64.7%) reached ≥ 7 mm after PRP administration. There was a significant difference between pre-PRP EMT and post-PRP EMT in all FET cycles, with mean difference of 3.0 ± 1.5 mm. Three cycles were cancelled for failure to reach adequate lining. Total pregnancy rate was 72.9% in our cohort of 48 cycles that proceeded to transfer. Clinical pregnancy rate was 54.2% (26/48 FET cycles); clinical miscarriage rate was 14.3% (5/35 pregnancies). Twenty six women had live birth (18 with EMT ≥ 7 mm and 8 with EMT < 7 mm). Response to PRP was not correlated with any pre-cycle characteristics. CONCLUSION We demonstrate a significant improvement in lining thickness and pregnancy rates in this challenging cohort of women after PRP infusion, with no adverse events. Cost-effectiveness of PRP with benefits and alternatives should be carefully considered.
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Affiliation(s)
- Lusine Aghajanova
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford School of Medicine, 1195 West Fremont Avenue, MC 7717, Sunnyvale, CA, 94087, USA.
| | - Amy Zhang
- Quantitative Sciences Unit, Department of Medicine, Stanford School of Medicine, Stanford, CA, USA
| | - Ruth B Lathi
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford School of Medicine, 1195 West Fremont Avenue, MC 7717, Sunnyvale, CA, 94087, USA
| | - Heather G Huddleston
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
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Peng Y, Du L, Yang B, Fan D, Jia S, Zheng C. Efficacy of platelet-rich plasma and platelet-rich fibrin in arthroscopic rotator cuff repair: A systematic review and meta-analysis. PM R 2023; 15:1643-1653. [PMID: 37526570 DOI: 10.1002/pmrj.13049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 06/27/2023] [Accepted: 07/07/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVE Basic scientific studies have demonstrated positive effects of platelet-rich therapies, such as platelet-rich plasma (PRP) and platelet-rich fibrin (PRF), on tendon repair. However, clinical evidence indicating improved prognosis is controversial. In this study, we aimed to determine whether augmentation of arthroscopic rotator cuff repair with PRP and PRF improves outcomes compared to arthroscopic repair alone. LITERATURE SURVEY PubMed, Embase, and Cochrane library databases were comprehensively searched for randomized controlled trials (RCTs) published until June 2022 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. No language restriction was applied. METHODOLOGY The primary outcomes were the rate of repeat tears after arthroscopic rotator cuff repair (retear rate) and clinical function scores (Constant-Murley Score, University of California, Los Angeles Score), and the extracted data were assessed for quality. Statistical analyses were performed using Review manager 5.3, and p < .05 was considered statistically significant. SYNTHESIS Ten RCTs with 628 patients were included. The results showed that augmenting surgery with PRP reduces retear rates compared to surgery alone (risk ratio [RR] = 0.40, 95% confidence interval [CI] 0.23-0.69, p = .001), whereas PRF has no effect on retear rates (p = .92). Regarding clinical function, PRP improves Constant-Murley scores (mean difference [MD] = 2.03, 95% CI 0.13-3.93, p = .04) and University of California, Los Angeles scores (MD = 1.30, 95% CI 0.36-2.24, p = .007), whereas PRF improves only Constant-Murley scores (MD = 3.93, 95% CI 1.50-6.36, p = .002). However, these differences were small and below the minimum clinically important difference threshold. CONCLUSIONS This study showed that compared to arthroscopic rotator cuff repair alone, the application of PRP in arthroscopic rotator cuff repair reduces retear rate and improves clinical function scores, whereas the application of PRF has no clinically meaningful benefit. The small number and heterogeneity of studies as well as methodological limitations and risk of bias limit confidence in the true effect.
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Affiliation(s)
- Yundong Peng
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Liang Du
- Department of Rehabilitation Medicine, PLA Middle Military Command General Hospital, Wuhan, China
| | - Bowen Yang
- Division of Pediatric Healthcare, Department of Pediatrics, Children's Rehabilitation Center, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Donghao Fan
- Department of Rehabilitation Medicine, People's Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Shaohui Jia
- Hubei Key Laboratory of Sport Training and Monitoring, College of Sports Medicine, Wuhan Sports University, Wuhan, China
| | - Cheng Zheng
- Department of Sports Medicine, Affiliated Hospital, Wuhan Sports University, Wuhan, China
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Ardebol J, Ghayyad K, Hwang S, Pak T, Menendez ME, Denard PJ. Patient-reported outcome tools and baseline scores vary by country and region for arthroscopic repair of massive rotator cuff tears: a systematic review. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:312-317. [PMID: 37588489 PMCID: PMC10426575 DOI: 10.1016/j.xrrt.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Different patient-reported outcome (PRO) tools are used in patients with arthroscopic rotator cuff repair (ARCR) which complicates outcome comparisons. The purpose of this systematic review was to compare PRO usage and baseline scores across world regions and countries in patients with ARCR of massive rotator cuff tears (MRCT). Methods A systematic review was performed on ARCR for MRCT. The search was conducted from September to November of 2022 using the MEDLINE database for articles published in the last 15 years. Thirty-seven articles were included after initial screening and full-text review. In each article, PRO usage, baseline scores, and country of origin were collected. PRO usage was reported in percentages and baseline scores were normalized for each region to facilitate comparisons. Normalization was performed using the PRO means from each article. These averages were converted to fractions using the worst and best possible scores. These were combined into a single numerical value, expressed as a decimal from 0 to 1, using the total sample size for each tool per region. Values closer to 0 represent worse functional outcomes. Results Thirty-two percent (n = 12) of articles were from Asia, 43.2% (n = 16) from Europe, 5.4% (n = 2) from the Middle East, and 18.9% (n = 7) from North America. The most commonly reported PRO tools were American Shoulder and Elbow Surgeons (ASES) in 19 papers, Constant-Murley Score (CMS) in 26 papers, Visual Analog Scale for pain (VAS) in 19 papers, and University of California in Los Angeles (UCLA) in 11 papers. ASES was reported in 51% of articles with 63% being from Asia (n = 12) compared to 21% from North America (n = 4). CMS was reported in 70% of studies with 58% being from Europe. Upon normalization, the preoperative score ranged from 0.30 to 0.44. Europe (0.39), and North America (0.40) showed similar scores. The lowest and highest scores were seen in the Middle East (0.3) and Asia (0.44) respectively. Conclusion There is no standardized method to report outcomes in patients undergoing ARCR for MRCT. Great variation in usage exists in PROs which complicates data comparison between world regions. With normalization, baseline scores where similar among Asia, North America, and Europe, and lowest in the Middle East.
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Affiliation(s)
- Javier Ardebol
- Shoulder Surgery, Oregon Shoulder Institute, Medford, OR, USA
| | - Kassem Ghayyad
- Shoulder Surgery, Oregon Shoulder Institute, Medford, OR, USA
| | - Simon Hwang
- Shoulder Surgery, Oregon Shoulder Institute, Medford, OR, USA
| | - Theresa Pak
- Shoulder Surgery, Oregon Shoulder Institute, Medford, OR, USA
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Lu J, Li H, Zhang Z, Xu R, Wang J, Jin H. Platelet-rich plasma in the pathologic processes of tendinopathy: a review of basic science studies. Front Bioeng Biotechnol 2023; 11:1187974. [PMID: 37545895 PMCID: PMC10401606 DOI: 10.3389/fbioe.2023.1187974] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/10/2023] [Indexed: 08/08/2023] Open
Abstract
Tendinopathy is a medical condition that includes a spectrum of inflammatory and degenerative tendon changes caused by traumatic or overuse injuries. The pathological mechanism of tendinopathy has not been well defined, and no ideal treatment is currently available. Platelet-rich plasma (PRP) is an autologous whole blood derivative containing a variety of cytokines and other protein components. Various basic studies have found that PRP has the therapeutic potential to promote cell proliferation and differentiation, regulate angiogenesis, increase extracellular matrix synthesis, and modulate inflammation in degenerative tendons. Therefore, PRP has been widely used as a promising therapeutic agent for tendinopathy. However, controversies exist over the optimal treatment regimen and efficacy of PRP for tendinopathy. This review focuses on the specific molecular and cellular mechanisms by which PRP manipulates tendon healing to better understand how PRP affects tendinopathy and explore the reason for the differences in clinical trial outcomes. This article has also pointed out the future direction of basic research and clinical application of PRP in the treatment of tendinopathy, which will play a guiding role in the design of PRP treatment protocols for tendinopathy.
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Affiliation(s)
- Jialin Lu
- Department of Pain, The Second Hospital of Jilin University, Changchun, China
- Norman Bethune Health Science Center of Jilin University, Changchun, China
| | - Han Li
- Norman Bethune Health Science Center of Jilin University, Changchun, China
| | - Ziyu Zhang
- Norman Bethune Health Science Center of Jilin University, Changchun, China
| | - Rui Xu
- Department of Endocrinology and Metabolism, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jincheng Wang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Hui Jin
- Department of Pain, The Second Hospital of Jilin University, Changchun, China
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
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20
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You T, Wu S, Ou X, Liu Y, Wang X. A network meta-analysis of arthroscopic rotator cuff repair. BMC Surg 2023; 23:201. [PMID: 37443010 PMCID: PMC10347875 DOI: 10.1186/s12893-023-02078-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 06/14/2023] [Indexed: 07/15/2023] Open
Abstract
OBJECTIVE Rotator cuff tear is a common shoulder injury that often leads to serious limitations in daily life. Herein, a network Meta-analysis using frequency theory was performed to evaluate the clinical outcomes of five rotator cuff repair techniques, including single-row repair, double-row repair, suture bridge repair, platelet-rich plasma therapy, and bone marrow stimulation, thus guiding clinical decision-making on rotator cuff repair. METHODS PubMed, EMbase, The Cochrane Library, and Web of Science were searched for randomized controlled trials and cohort studies comparing rotator cuff repair techniques published from inception to May 2022. Combined analysis and quality assessment were performed using software STATA15.1 and Review Manager5.3. RESULTS A total of 51 articles were finally included, including 27 randomized controlled trials and 24 cohort studies. Results from the network Meta-analysis showed that: (1) In terms of the American Shoulder and Elbow Surgeons score, platelet-rich plasma therapy, double-row repair, bone marrow stimulation, and single-row repair were significantly better than suture bridge repair. (2) In terms of Constant score, bone marrow stimulation was significantly better than double-row repair, single-row repair, and suture bridge repair. (3) In terms of visual analog scale score, platelet-rich plasma therapy was significantly better than double-row repair and suture bridge repair. (4) In terms of the Shoulder Rating Scale of the University of California at Los Angeles score, platelet-rich plasma therapy and double-row repair were relatively better but not significantly different from the other treatments. (5) In terms of the risk of re-tear, the re-tear rate of platelet-rich plasma therapy and double-row repair was significantly lower than that of single-row repair and suture bridge repair. CONCLUSION Based on the results of network Meta-analysis and surface under the cumulative ranking, platelet-rich plasma therapy, bone marrow stimulation, and double-row repair have good overall rehabilitation effects. It is recommended to choose appropriate repair techniques as per the actual clinical situation.
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Affiliation(s)
- Tianshu You
- School of Electrical Engineering and Computer, Jilin Jianzhu University, Changchun, Jilin Province, China
| | - Siyu Wu
- Department of Hand Surgery, the Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Xiaolan Ou
- Department of Hand Surgery, the Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Ying Liu
- Department of Cardiology, Jilin Province Hospital, Changchun, Jilin Province, China
| | - Xu Wang
- School of Electrical Engineering and Computer, Jilin Jianzhu University, Changchun, Jilin Province, China.
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21
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Lv M, Xu Q, He F, Guo J, Zheng Z, Xie J, Wang W. Transosseous-Equivalent/Suture Bridge Technique in Combination With Platelet-Rich Plasma Application Yield Optimal Clinical Outcomes in Arthroscopic Rotator Cuff Repair: A Bayesian Network Analysis of Randomized Controlled Trials. Arthroscopy 2023; 39:425-437.e1. [PMID: 36343767 DOI: 10.1016/j.arthro.2022.10.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 10/22/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE To assess the clinical evidence defining the optimal combination of arthroscopic suture technique and platelet-rich products (PRP), and application for arthroscopic rotator cuff repair (ARCR). METHODS All level of evidence (LOE) I randomized controlled trials (RCT) focusing on arthroscopic suture technique and/or PRP application in ARCR were included. The exclusion criteria were LOE II or worse, studies with other interventions, studies reported none of the predetermined clinical outcomes; studies unable to extract any precise data; studies from the same patient group of included studies. A pair-wise meta-analysis and Bayesian network analysis were performed on each comparison. The intervention options were ranked by Bayesian network analysis. RESULTS 27 studies comprising 1,947 individuals met the inclusion criteria. The application of transosseous equivalent/suture bridge repair (SB) with PRP (SB+PRP) significantly reduced retear rate (risk ratio [RR], 0.29; 95% confidence interval [CI], [0.15, 0.55].) and increased Constant-Murley score (mean difference, 1.90; 95% CI, [0.14, 3.74]), compared to SB repair. Single-row repair (SR) with PRP usage (SR+PRP) significantly reduced retear rate (RR, 0.27; 95% CI, [0.12, 0.55]) and pain visual analog scale (VAS) (mean difference: -0.84; 95% CI [-1.39, -0.46].), increased University of California, Los Angeles (UCLA) shoulder score (mean difference: 1.48; 95% CI [0.50, 2.58]) and Constant-Murley score (mean difference: 4.53; 95% CI [2.65, 6.38]), compared to SR repair. The ranking for outcomes demonstrated SB+PRP resulted in the best retear rate, UCLA shoulder score, with the second-best postoperative pain, Constant-Murley score, while SR+PRP resulted in the best postoperative pain, Constant-Murley score, with the second-best retear rate and UCLA score. CONCLUSION Arthroscopic rotator cuff repair utilizing SB+PRP yields optimal retear rate and UCLA shoulder score, with the second-best postoperative pain and Constant-Murley shoulder outcome score, while SR+PRP yields the best in these two parameters. LEVEL OF EVIDENCE Level I, Bayesian network analysis of level I RCT.
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Affiliation(s)
- Minchao Lv
- Department of Orthopedics, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, Zhejiang Province, China
| | - Qingxin Xu
- Clinical and Translational Research Center, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Feixiong He
- Department of Orthopedics, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, Zhejiang Province, China
| | - Jinku Guo
- Department of Orthopedics, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, Zhejiang Province, China
| | - Zhenxin Zheng
- Department of Orthopedics, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, Zhejiang Province, China
| | - Jun Xie
- Department of Orthopedics, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, Zhejiang Province, China
| | - Wei Wang
- Department of Orthopedics, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, Zhejiang Province, China.
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22
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Trantos IA, Vasiliadis ES, Giannoulis FS, Pappa E, Kakridonis F, Pneumaticos SG. The Effect of PRP Augmentation of Arthroscopic Repairs of Shoulder Rotator Cuff Tears on Postoperative Clinical Scores and Retear Rates: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12020581. [PMID: 36675510 PMCID: PMC9860857 DOI: 10.3390/jcm12020581] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 12/24/2022] [Accepted: 01/08/2023] [Indexed: 01/13/2023] Open
Abstract
The aim of this review and meta-analysis is to assess recent clinical trials concerning the combination of operative treatment of rotator cuff tears and the administration of PRP and its effect on clinical scores and postoperative retear rates. The trials were used to compare the combination of PRP treatment and arthroscopic rotator cuff repair to arthroscopy alone. Twenty-five clinical trials were reviewed. A risk-of-bias assessment was made for all randomized clinical trials included, using the Cochrane collaboration’s tool as well as a quality assessment for all non-randomized studies utilizing the Newcastle−Ottawa scale. The PRP-treated patients showed statistically significant improvement postoperatively compared to control groups concerning the Constant−Murley (mean difference 2.46, 95% CI 1.4−3.52, p < 0.00001), SST (mean difference 0.32, 95% CI 0.02−0.63, p = 0.04), and UCLA (mean difference 0.82, 95% CI 0.23−1.43, p = 0.07) scores. A statistically significant decrease of retear rates in the PRP-treated patients, with a risk ratio of 0.78 (95% CI 0.65−0.94, p = 0.01), was found. We believe that the results presented have positive aspects, especially concerning the retear risk, but are yet inconclusive concerning clinical results such as shoulder pain and function.
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Affiliation(s)
| | - Elias S. Vasiliadis
- 3rd Department of Orthopaedic Surgery, KAT Hospital, University of Athens, 14561 Athens, Greece
| | | | - Eleni Pappa
- 5th Department of Orthopaedic Surgery, KAT Hospital, 14561 Athens, Greece
| | - Fotios Kakridonis
- 5th Department of Orthopaedic Surgery, KAT Hospital, 14561 Athens, Greece
| | - Spyros G. Pneumaticos
- 3rd Department of Orthopaedic Surgery, KAT Hospital, University of Athens, 14561 Athens, Greece
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23
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Uyeki CL, Perry NP, Farina EM, Wang C, Nascimento RJ, Mazzocca AD. Biologic Adjuvants for Rotator Cuff Augmentation. OPER TECHN SPORT MED 2023. [DOI: 10.1016/j.otsm.2023.150988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Platelet-rich plasma does not improve clinical results in patients with rotator cuff disorders but reduces the retear rate. A systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 31:1940-1952. [PMID: 36496450 DOI: 10.1007/s00167-022-07223-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/04/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE To assess whether the use of Platelet-rich plasma (PRP) produces a clinical benefit in patients with rotator cuff disorders, treated either conservatively or surgically. METHODS A systematic review was performed according to PRISMA guidelines on three databases (PubMed, Cochrane Library, Web of Science) to identify randomised controlled trials (RCTs) on the use of PRP in patients with rotator cuff disorders, treated either conservatively or surgically. A meta-analysis was performed on articles reporting results for Constant, UCLA, VAS, SST scores and retear rate. The RoB 2.0 and the modified Coleman Methodology Score were used to assess methodological quality. RESULTS A total of 36 RCTs (20 surgical, 16 conservative) were included, for a total of 2,443 patients. Conservative treatment showed high heterogeneity and no clear consensus in favour of PRP. The meta-analysis of the studies with surgical treatment showed no benefit in using PRP in any of the clinical outcomes, either at the short or medium/long-term follow-up. However, the retear rate was lower with PRP augmentation (p < 0.001). The overall quality of the studies was moderate to high, with the surgical studies presenting a lower risk of bias than the conservative studies. CONCLUSION The use of PRP as augmentation in rotator cuff surgical repair significantly reduces the retear rate. However, no benefits were documented in terms of clinical outcomes. PRP application through injection in patients treated conservatively also failed to present any clear advantage. While there are many studies in the literature with several RCTs of moderate to high quality, the high heterogeneity of products and studies remains a significant limitation to fully understanding PRP potential in this field. LEVEL OF EVIDENCE Level I.
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25
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Schoch BS, Werner BC, Shapiro SA, Camp CL, Chalmers PN, Cancienne JM. Effect of Bone Marrow Aspirate Concentrate and Platelet-Rich Plasma Augmentation on the Rate of Revision Rotator Cuff Repair. Orthop J Sports Med 2022; 10:23259671221127004. [PMID: 36353396 PMCID: PMC9638537 DOI: 10.1177/23259671221127004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/05/2022] [Indexed: 11/05/2022] Open
Abstract
Background The application of orthobiologics at the time of arthroscopic rotator cuff repair (RCR) has received an increasing amount of clinical interest despite a relative scarcity of human clinical studies on their efficacy. Purpose To utilize a national administrative database to determine the association of bone marrow aspirate concentrate (BMAC) and platelet-rich plasma (PRP) applied at the time of RCR with revision surgery rates. Study Design Cohort study; Level of evidence, 3. Methods The Mariner data set from the PearlDiver patient records repository was utilized to identify patients undergoing RCR using Current Procedural Terminology (CPT) code 29827. Patients receiving BMAC or PRP at the time of RCR were then identified using CPT coding. For comparison purposes, a matched cohort was created consisting of patients who underwent RCR without biologic augmentation in a 5:1 fashion for each biologic separately. Cases were matched according to age, sex, tobacco use, biceps tenodesis, distal clavicle excision, and subacromial decompression. All groups were then queried for revision RCR or conversion to reverse shoulder arthroplasty. Revision rates were compared utilizing a multivariate binomial logistic regression analysis. Adjusted odds ratios (ORs) and 95% CIs were calculated. Results A total of 760 patients who underwent biologic augmentation during RCR were identified, including 646 patients in the PRP group and 114 patients in the BMAC group. They were compared with 3800 matched controls without documented biologic application at the time of surgery. Compared with matched controls, patients who received BMAC at the time of surgery experienced a significantly lower incidence of revision surgery at 2 years (OR, 0.36; 95% CI, 0.15-0.82; P = .015). There was no significant difference in revision rates between PRP and matched controls (OR, 0.87; 95% CI, 0.62-1.23; P = .183). Conclusion The application of BMAC at the time of RCR was associated with a significant decrease in the incidence of revision surgery. There was no apparent effect of PRP on the incidence of revision surgery after primary RCR. Higher-level clinical studies considering surgical factors are needed to more clearly define the role of biologic adjuvants in RCR.
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Affiliation(s)
- Bradley S. Schoch
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville,
Florida, USA
| | - Brian C. Werner
- Department of Orthopaedic Surgery, University of Virginia,
Charlottesville, Virginia, USA
| | - Shane A. Shapiro
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville,
Florida, USA
| | | | - Peter N. Chalmers
- Department of Orthopedic Surgery, University of Utah, Salt Lake
City, Utah, USA
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26
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Celli A, Paroni C, Bonucci P, Celli L. Long-term outcomes of teres major transfer for irreparable posterosuperior rotator cuff tears in patients aged <65 years. JSES Int 2022; 7:35-43. [PMID: 36820419 PMCID: PMC9937853 DOI: 10.1016/j.jseint.2022.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Background Massive rotator cuff tears are defined as irreparable when tendon-to-bone or tendon-to-tendon continuity with the adducted arm cannot be restored and severe muscle fatty infiltration is present. Tendon transfer is a palliative procedure that improves shoulder function and relieves pain. Methods We reviewed the records of patients aged <65 years, whose irreparable posterosuperior rotator cuff tears had been managed with teres major tendon transfer at our institution. Their 5- and 10-year clinical and radiographic follow-up records were examined to assess long-term outcomes. Patients' Constant Score, Disabilities of the Arm, Shoulder, and Hand score, and the visual analog scale for pain were calculated before the procedure and at 5 and 10 years. Results There were 24 consecutive patients aged <65 years (mean, 59; 12 men and 12 women) who had received no prior treatment except rehabilitation. All patients underwent teres major tendon transfer due to the failure of conservative treatment. The mean Constant Score was 26 preoperatively and 68 and 66 at 5 and 10 years, respectively (P = .0001 and P = .25). The mean Disabilities of the Arm, Shoulder, and Hand scores were 62.2 preoperatively and 7.8 and 9.3 at 5 and 10 years, respectively (P = .0009 and P = .1). The mean visual analog scale scores at rest were 6.1 preoperatively, and 0.3 and 0.5 at 5 and 10 years, respectively (P = .0003 and P = .1). Based on Hamada's classification, at 5 years, 3 patients showed grade 2 changes, and another had grade 3 changes; at 10 years, 7 patients showed grade 2 changes, and one showed grade 3 changes. Complications (8%) developed after the 10-year evaluation and included pain in 1 patient and secondary rupture of the transfer in another. Discussion Improving shoulder function and reducing pain in relatively young patients with irreparable posterosuperior cuff tears involves replacing the lost muscle with a muscle-tendon transfer. The chief aims of the procedure are to restore the balance with the subscapularis muscle, achieve joint stability, keep the humeral head in the glenoid cavity, and improve shoulder abduction and external rotation. Teres major tendon transfer can achieve these goals. Altogether, 22 of our 24 patients experienced improved daily activity function and pain relief that became stable after 5 years. Teres major transfers are useful surgical procedures, particularly in younger patients and in those with high functional demands, providing good and stable long-term results.
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Affiliation(s)
- Andrea Celli
- Corresponding author: Andrea Celli, MD, Via Emilia Est 380∖1 Modena 41124, Italy.
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Zhang X, Wang D, Wang Z, Ling SKK, Yung PSH, Tuan RS, Ker DFE. Clinical perspectives for repairing rotator cuff injuries with multi-tissue regenerative approaches. J Orthop Translat 2022; 36:91-108. [PMID: 36090820 PMCID: PMC9428729 DOI: 10.1016/j.jot.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/15/2022] [Accepted: 06/21/2022] [Indexed: 11/25/2022] Open
Abstract
Background In the musculoskeletal system, bone, tendon, and muscle form highly integrated multi-tissue units such as the rotator cuff complex, which facilitates functional and dynamic movement of the shoulder joint. Understanding the intricate interplay among these tissues within clinical, biological, and engineering contexts is vital for addressing challenging issues in treatment of musculoskeletal disorders and injuries. Methods A wide-ranging literature search was performed, and findings related to the socioeconomic impact of rotator cuff tears, the structure-function relationship of rotator cuff bone-tendon-muscle units, pathophysiology of injury, current clinical treatments, recent state-of-the-art advances (stem cells, growth factors, and exosomes) as well as their regulatory approval, and future strategies aimed at engineering bone-tendon-muscle musculoskeletal units are outlined. Results Rotator cuff injuries are a significant socioeconomic burden on numerous healthcare systems that may be addressed by treating the rotator cuff as a single complex, given its highly integrated structure-function relationship as well as degenerative pathophysiology and limited healing in bone-tendon-muscle musculoskeletal tissues. Current clinical practices for treating rotator cuff injuries, including the use of commercially available devices and evolving trends in surgical management have benefited patients while advances in application of stem/progenitor cells, growth factors, and exosomes hold clinical potential. However, such efforts do not emphasize targeted regeneration of bone-tendon-muscle units. Strategies aimed at regenerating bone-tendon-muscle units are thus expected to address challenging issues in rotator cuff repair. Conclusions The rotator cuff is a highly integrated complex of bone-tendon-muscle units that when injured, has severe consequences for patients and healthcare systems. State-of-the-art clinical treatment as well as recent advances have resulted in improved patient outcome and may be further enhanced by engineering bone-tendon-muscle multi-tissue grafts as a potential strategy for rotator cuff injuries. Translational Potential of this Article This review aims to bridge clinical, tissue engineering, and biological aspects of rotator cuff repair and propose a novel therapeutic strategy by targeted regeneration of multi-tissue units. The presentation of these wide-ranging and multi-disciplinary concepts are broadly applicable to regenerative medicine applications for musculoskeletal and non-musculoskeletal tissues.
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Affiliation(s)
- Xu Zhang
- Institute for Tissue Engineering and Regenerative Medicine, Hong Kong
- School of Biomedical Sciences, Hong Kong
| | - Dan Wang
- Institute for Tissue Engineering and Regenerative Medicine, Hong Kong
- School of Biomedical Sciences, Hong Kong
- Ministry of Education Key Laboratory for Regenerative Medicine, School of Biomedical Sciences, Hong Kong
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
- Center for Neuromusculoskeletal Restorative Medicine, Hong Kong Science Park, Hong Kong
| | - Zuyong Wang
- College of Materials Science and Engineering, Hunan University, Changsha, China
| | - Samuel Ka-kin Ling
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
- Center for Neuromusculoskeletal Restorative Medicine, Hong Kong Science Park, Hong Kong
| | - Patrick Shu-hang Yung
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
- Center for Neuromusculoskeletal Restorative Medicine, Hong Kong Science Park, Hong Kong
| | - Rocky S. Tuan
- Institute for Tissue Engineering and Regenerative Medicine, Hong Kong
- School of Biomedical Sciences, Hong Kong
- Center for Neuromusculoskeletal Restorative Medicine, Hong Kong Science Park, Hong Kong
| | - Dai Fei Elmer Ker
- Institute for Tissue Engineering and Regenerative Medicine, Hong Kong
- School of Biomedical Sciences, Hong Kong
- Ministry of Education Key Laboratory for Regenerative Medicine, School of Biomedical Sciences, Hong Kong
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
- Center for Neuromusculoskeletal Restorative Medicine, Hong Kong Science Park, Hong Kong
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Zhang C, Cai YZ, Wang Y. Injection of Leukocyte-Poor Platelet-Rich Plasma for Moderate-to-Large Rotator Cuff Tears Does Not Improve Clinical Outcomes but Reduces Retear Rates and Fatty Infiltration: A Prospective, Single-Blinded Randomized Study. Arthroscopy 2022; 38:2381-2388.e1. [PMID: 35247512 DOI: 10.1016/j.arthro.2022.02.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 02/06/2022] [Accepted: 02/06/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine whether leukocyte-poor platelet-rich plasma (Lp-PRP) reduced retear rates, reduced fatty infiltration, and improved functional outcomes in patients with degenerative moderate-to-large rotator cuff tears. METHODS This was a randomized controlled study at a single center. A consecutive series of 104 patients with moderate-to-large rotator cuff tears was enrolled and randomly allocated to a control group (double-row suture-bridge arthroscopic rotator cuff repair alone, n = 52) and a study group (double-row suture-bridge repair followed by 3 Lp-PRP injections at the tendon repair site during surgery, at days 7 and 14 after surgery, n = 52). All patients were followed up for 27.2 months (range 24-36 months), with University of California at Los Angeles (UCLA) shoulder rating scale, the Constant score, and a visual analog scale (VAS) evaluated respectively. The integrity and fatty infiltration of repaired tissue were assessed by magnetic resonance imaging using the Sugaya classification and Goutallier grade classification at 24 months after surgery. Statistical analysis was performed based on the t test, χ2 test, and the Kendall tau-b correlation coefficient. RESULTS Four patients refused follow-up, and 11 patients had incomplete data. Eventually, a total of 89 patients were available for 24 months follow-up. The mean UCLA score increased from 14.80 ± 2.53 to 29.37 ± 2.06 in control group and from 13.74 ± 3.30 to 30.14 ± 2.32 in study group (P = .103). The mean Constant score increased from 46.56 ± 5.90 to 86.83 ± 4.94 in control group and from 44.37 ± 7.92 to 88.80 ± 4.92 in study group (P = .063). The VAS score decreased from 3.22 ± 1.24 to 0.97 ± 1.12 in control group and in 3.49 ± 1.52 to 1.16 ± 0.99 in study group (P = .41). All differences in UCLA score, Constant score, and VAS between pre- and postoperation achieved minimal clinically important differences proposed for arthroscopic rotator cuff repair. Of the 89 patients, 76 had magnetic resonance imaging performed at 24 months after surgery. The retear rate was 17.6% in study group, which was lower than that in control group (38.1%, P = .049). In addition, the Goutallier grade was found to be significant difference between groups postoperatively (Kendall tau-b -0.24, P = .03) but no significant difference preoperatively (Kendall tau-b -0.18, P = .11). There were no complications in the patients. CONCLUSIONS Our procedures involving repeated injections of Lp-PRP during surgery and at days 7 and 14, as described in this study, have positive effects on reducing retear rate and promoting Goutallier grade in patients following arthroscopic rotator cuff repair and could also provide substantial clinical outcomes that reach the minimal clinically important difference for surgical treatment. However, given the numbers available for analysis, it did not promote better clinical results when compared with the control group. LEVEL OF EVIDENCE II, randomized controlled study.
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Affiliation(s)
- Chi Zhang
- Center for Sports Medicine, Hangzhou, China; First Affiliated Hospital, Zhejiang University School of Medicine and Institute of Sports Medicine of Zhejiang University, Hangzhou, China
| | - You-Zhi Cai
- Center for Sports Medicine, Hangzhou, China; First Affiliated Hospital, Zhejiang University School of Medicine and Institute of Sports Medicine of Zhejiang University, Hangzhou, China.
| | - Yue Wang
- Spine Lab, Department of Orthopedic Surgery, Hangzhou, China.
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Lacheta L, Braun S. Limited evidence for biological treatment measures for cartilage and tendon injuries of the shoulder. Knee Surg Sports Traumatol Arthrosc 2022; 30:1132-1137. [PMID: 33609150 DOI: 10.1007/s00167-021-06499-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/08/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To critically review the available literature on the usage of biologics to treat cartilage and tendon injuries of the shoulder. METHODS Four different databases were searched in January 2020 for studies reporting data on bone marrow stimulation, autologous chondrocyte implantation, platelet-rich plasma, autologous concentrated serum, and bone marrow aspirate concentrate for the treatment of cartilage and/or tendon injuries of the shoulder. Prospective, retrospective, cohort and case-control studies as well as case series, systematic reviews and laboratory studies (involving human tissue) were included. Cadaveric or animal studies were excluded. Findings were summarized and an expert opinion on trends was provided. RESULTS Although there is limited literature available on biologics in cartilage lesions of the shoulder, the advancement from micro- to nanofracture, that is well established for the treatment of cartilage lesions in the knee, may be the next step in the treatment of shoulder lesions as well. The high rate of failure and therefore the complexity of tendon healing following rotator cuff repair has led to a rising interest in biologic augmentation such as platelet-rich plasma and stem cells to enhance tendon-bone-healing and to decrease the prevalence of failure. Despite the increase in publications, there exists a huge heterogeneity of content, quality, and quantity of among studies and their processing methods reporting the use of platelet-rich plasma in rotator cuff repair. CONCLUSION Conclusions from individual studies cannot be generalized. Currently, no evidence supports that platelet-rich plasma provides clinical benefits in rotator cuff repair. Similar is reported for microfracture in rotator cuff repair, however, despite no clinical benefits, microfracture has shown to reduce the appearance of structural failures. Although some evidence exists for the use of stem cells form bone marrow aspirate concentrate, results from large case series are still lacking. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Lucca Lacheta
- Center for Musculosceletal Surgery, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Sepp Braun
- Gelenkpunkt, Sports and Joint Surgery Innsbruck, Innsbruck, Austria. .,Research Unit for Orthopaedic Sports Medicine and Injury Prevention, Medical Informatics and Technology, University for Health Sciences, Hall, Austria.
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Peng Y, Guanglan W, Jia S, Zheng C. Leukocyte-Rich and Leukocyte-Poor Platelet-Rich Plasma in Rotator Cuff Repair: A Meta-analysis. Int J Sports Med 2022; 43:921-930. [PMID: 35255508 DOI: 10.1055/a-1790-7982] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
To systematically review of randomized controlled trials(RCTs) to compared the effects of leukocyte-rich and leukocyte-poor platelet-rich plasma in arthroscopic rotator cuff repair. Two independent reviewers comprehensively searched PubMed, Embase, and Cochrane library databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Comparison of leukocyte-rich platelet-rich plasma or leukocyte-poor platelet-rich plasma in rotator cuff repair in a level I RCTs. Methodological quality assessment was carried out using Cochrane Review Manager 5.3 software. P<0.05 was considered statistically significant. Nine RCTs with 540 patients were included in this review. Meta-analysis showed that leukocyte-poor platelet-rich plasma in significantly reduced retear rate in rotator cuff repair [RR=0.56 95%CI (0.42,0.75); P＜0.05), and in clinical results, the constant score [MD=3.67, 95%CI (1.62,5.73); P=0.0005], UCLA score [MD=1.60, 95%CI (0.79,2.42); P=0.0001], ASES score [MD=2.16, 95%CI(0.12,4.20);P=0.04] were significantly improved. There was a significant result in favor of PRP for the Constant score [MD=-1.24, 95%CI(-1.50,-0.99); P＜0.00001], while SST scores were not significantly different among all groups [MD=0.21, 95%CI(-0.21,0.64); P=0.32]. In conclusion, leukocyte-poor platelet-rich plasma can improved the clinical function and reduced retear rate in arthroscopic rotator cuff repair. In contrast, the efficacy of leukocyte-rich platelet-rich plasma was not significantly improved with the exception of VAS score.
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Affiliation(s)
- Yundong Peng
- College of Health Science, Wuhan Sports University, Wuhan, China
| | - Wang Guanglan
- School of Health Sciences, Wuhan Sports University, Wuhan, China
| | - Shaohui Jia
- College of Health Science, Wuhan Sports University, Wuhan, China
| | - Cheng Zheng
- Department of Sports Medicine, Affiliated Hospital, Wuhan Sports University, Wuhan, China
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Better Short-Term Outcomes After Rotator Cuff Repair in Studies With Poorer Mean Shoulder Scores and Predominantly Small to Medium-Sized Tears at Baseline: A Systematic Review and Meta-analysis. Arthroscopy 2022; 38:967-979.e4. [PMID: 34450217 DOI: 10.1016/j.arthro.2021.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 08/03/2021] [Accepted: 08/10/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To perform a meta-analysis to explore factors associated with clinical and structural short-term outcomes in randomized and nonrandomized prospective studies of rotator cuff repair. METHODS Medline, clinicaltrials.gov, and Mendeley were searched for literature published from January 2000 to December 2020 to identify randomized controlled trials (RCT) and nonrandomized prospective cohort studies (PCS) describing the outcome of surgical repair of full-thickness rotator cuff tears. Study quality was assessed by two independent reviewers. We calculated standardized mean difference (SMD) from baseline to follow-up in each trial arm, preferably at 12 months follow-up. Between-study heterogeneity of outcomes, small-study effects and rates of retear were assessed. Meta-regression was performed to estimate associations between prespecified variables and clinical and structural outcomes. RESULTS Outcomes in 64 RCT and 19 PCS trial arms were analyzed. Median age was 59 years. There was substantial between-study heterogeneity in clinical outcomes (SMD range: .42 to 6.44; I2 = 93% in RCT, 88% in PCS) and summary estimates were not calculated. On the basis of multivariate analysis, better clinical outcome was associated with lower (worse) mean outcome value at baseline, smaller tear size, and lower proportion of large-massive tears (R2 = 56 and 44%, respectively). Overall retear rate at median 13-month follow-up was 19.9% (interquartile range: 10-30). Higher mean age together with larger tear size and higher proportion of large-massive tears were associated with increased retear rates (R2 = 33% and 58%, respectively). Clinical outcome was not significantly related to rate of retear. CONCLUSIONS Studies with lower mean outcome values at baseline and predominantly small- to medium-sized tears reported better clinical outcomes. Studies with higher mean age and a predominance of large-massive tears had significantly increased retear rates, but retear rates were not associated with clinical outcome. LEVEL OF EVIDENCE Level II, meta-analysis of level I and II studies.
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Platelet-Rich Plasma Has Better Results for Retear Rate, Pain, and Outcome Than Platelet-Rich Fibrin After Rotator Cuff Repair: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Arthroscopy 2022; 38:539-550. [PMID: 34052384 DOI: 10.1016/j.arthro.2021.05.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 05/02/2021] [Accepted: 05/15/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE To perform a systematic review and meta-analysis of randomized controlled trials (RCTs) in the literature to ascertain the extent to which platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) improved patient outcomes in arthroscopic rotator cuff repair. METHODS Two independent reviewers performed the literature search based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, with a third author resolving any discrepancies. RCTs comparing PRP or PRF to a control in rotator cuff repair were included. Quality of evidence was assessed using the Cochrane Collaboration risk of bias tool. Clinical outcomes were compared using the risk ratio for dichotomous variables and the mean difference for continuous variables. A P value <.05 was deemed statistically significant. RESULTS Included in this review are 23 RCTs with 1440 patients. PRP resulted in significantly decreased rates of retear (15.9% versus 29.0%, respectively; P < .0001). Significant results were noted in favor of PRP compared with control based on the Constant score (83.9 versus 81.2, respectively; P = .0006); the University of California, Los Angeles score (31.1 versus 30.2; P < .00001); the American Shoulder and Elbow Surgeons score (87.3 versus 84.5; P = .04); and the visual analog scale score (1.3 versus 1.6; P = .01). PRF resulted in an improved Constant score (80.1 versus 80.0, respectively; P = .04) compared with control. CONCLUSIONS The current evidence shows that using PRP in arthroscopic rotator cuff repair can improve pain levels and functional outcome scores while reducing the retear rate after surgery. PRF injection, on the other hand, improves only the Constant score. LEVEL OF EVIDENCE II; systematic review and meta-analysis of level I and II evidence.
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Colbath G, Murray A, Siatkowski S, Pate T, Krussig M, Pill S, Hawkins R, Tokish J, Mercuri J. Autograft Long Head Biceps Tendon Can Be Used as a Scaffold for Biologically Augmenting Rotator Cuff Repairs. Arthroscopy 2022; 38:38-48. [PMID: 34126215 PMCID: PMC8665938 DOI: 10.1016/j.arthro.2021.05.064] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 05/23/2021] [Accepted: 05/31/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE We create a viable, mechanically expanded autograft long head biceps tendon (LHBT) scaffold for biologically augmenting the repair of torn rotator cuffs. METHODS The proximal aspect of the tenotomized LHBTs was harvested from patients during rotator cuff repair surgery and was mechanically formed into porous scaffolds using a surgical graft expander. LHBT scaffolds were evaluated for change in area, tensile properties, and tenocyte viability before and after expansion. The ability of endogenous tenocytes derived from the LHBT scaffold to promote tenogenic differentiation of human adipose-derived mesenchymal stromal cells (ADMSCs) was also determined. RESULTS Autograft LHBTs were successfully expanded using a modified surgical graft expander to create a porous scaffold containing viable resident tenoctyes from patients undergoing rotator cuff repair. LHBT scaffolds had significantly increased area (length: 24.91 mm [13.91, 35.90] × width: 22.69 mm [1.87, 34.50]; P = .011) compared with the native LHBT tendon (length: 27.16 mm [2.70, 33.62] × width: 6.68 mm [5.62, 7.74]). The structural properties of the autograft were altered, including the ultimate tensile strength (LHBT scaffold: .56 MPa [.06, 1.06] vs. native LHBT: 2.35 MPa [1.36, 3.33]; P = .002) and tensile modulus (LHBT scaffold: 4.72 MPa [-.80, 1.24] versus native LHBT: 37.17 MPa [24.56, 49.78]; P = .001). There was also a reduction in resident tenocyte percent viability (LHBT scaffold: 38.52% [17.94, 59.09] vs. native LHBT: 68.87% [63.67, 74.37]; P =.004). Tenocytes derived from the LHBT scaffold produced soluble signals that initiated ADMSC differentiation into an immature tenocyte-like phenotype, as indicated by an 8.7× increase in scleraxis (P = .040) and a 3.6× increase in collagen type III mRNA expression (P = .050) compared with undifferentiated ADMSC controls. CONCLUSIONS The ability to produce a viable autologous scaffold from the proximal biceps tendon having dimensions, porosity, mechanical characteristics, native ECM components, and viable tenocytes that produce bioactive signals conducive to supporting the biologic augmentation of rotator cuff repair surgery has been demonstrated. CLINICAL RELEVANCE This biologically active construct may help to improve the quality of healing and regeneration at the repair site of rotator cuff tears, especially those at high risk for retear.
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Affiliation(s)
- Gregory Colbath
- Medical Group of the Carolinas, Department of Orthopaedic Surgery, Spartanburg Regional, Spartanburg, SC
| | - Alison Murray
- Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Department of Bioengineering, Clemson University, Clemson, SC,Frank H. Stelling and C. Dayton Riddle Orthopaedic Education and Research Laboratory, Clemson University Biomedical Engineering Innovation Campus, Greenville, SC
| | - Sandra Siatkowski
- Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Department of Bioengineering, Clemson University, Clemson, SC,Frank H. Stelling and C. Dayton Riddle Orthopaedic Education and Research Laboratory, Clemson University Biomedical Engineering Innovation Campus, Greenville, SC
| | - Taylor Pate
- Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Department of Bioengineering, Clemson University, Clemson, SC,Frank H. Stelling and C. Dayton Riddle Orthopaedic Education and Research Laboratory, Clemson University Biomedical Engineering Innovation Campus, Greenville, SC
| | - Mario Krussig
- Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Department of Bioengineering, Clemson University, Clemson, SC,Frank H. Stelling and C. Dayton Riddle Orthopaedic Education and Research Laboratory, Clemson University Biomedical Engineering Innovation Campus, Greenville, SC
| | - Stephan Pill
- Steadman Hawkins Clinic of the Carolinas, Department of Orthopaedic Surgery, Prisma Health, Greenville, SC
| | - Richard Hawkins
- Steadman Hawkins Clinic of the Carolinas, Department of Orthopaedic Surgery, Prisma Health, Greenville, SC
| | - John Tokish
- Mayo Clinic, Department of Orthopaedic Surgery, Phoenix, AZ
| | - Jeremy Mercuri
- Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Department of Bioengineering, Clemson University, Clemson, SC,Frank H. Stelling and C. Dayton Riddle Orthopaedic Education and Research Laboratory, Clemson University Biomedical Engineering Innovation Campus, Greenville, SC
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DeClercq MG, Fiorentino AM, Lengel HA, Ruzbarsky JJ, Robinson SK, Oberlohr VT, Whitney KE, Millett PJ, Huard J. Systematic Review of Platelet-Rich Plasma for Rotator Cuff Repair: Are We Adhering to the Minimum Information for Studies Evaluating Biologics in Orthopaedics? Orthop J Sports Med 2021; 9:23259671211041971. [PMID: 34901286 PMCID: PMC8655472 DOI: 10.1177/23259671211041971] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 05/19/2021] [Indexed: 01/08/2023] Open
Abstract
Background The therapeutic efficacy of orthobiologic therapies for rotator cuff repair is difficult to evaluate owing to reporting inconsistences. In response, the Minimum Information for Studies Evaluating Biologics in Orthopaedics (MIBO) guidelines were developed to ensure standard reporting on orthobiologic therapies. Purpose To systematically review clinical studies evaluating platelet-rich plasma (PRP) for full-thickness rotator cuff repair and adherence to MIBO guidelines. Study Design Scoping review; Level of evidence, 4. Methods A search was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using PubMed, EMBASE, and the Cochrane Library databases. Inclusion criteria were clinical studies reporting on rotator cuff tears (≥1 cm) surgically repaired with PRP. Patient demographics, biologic intervention, and adherence to the MIBO guidelines were systematically reviewed. Results A total of 19 studies (1005 patients) were included in this review. Across all studies, 58.5% of the MIBO checklist items for PRP were reported. Out of 47 checklist items, 19 were reported in over 85% of studies, whereas 22 were reported in less than half of studies. Details of whole-blood processing and characteristics, as well as PRP processing and characteristics, were reported inconsistently, and no study provided adequate information to enable the precise replication of preparation protocols for PRP. Conclusion This systematic review highlights the current reporting deficiencies within the scientific literature of important variables for evaluating PRP for full-thickness rotator cuff repair. There was widespread variability among published studies that evaluate PRP for this application and, more specifically, studies were limited by inconsistent universal reporting of whole-blood and PRP processing and postprocessing characteristics. To improve our understanding of biologic efficacy and to promote repeatability, stricter adherence to the MIBO guidelines is necessary. We propose that the checklist limitations be addressed and that modification of the MIBO guidelines be considered to improve the reporting of individual components within certain categories.
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Affiliation(s)
- Madeleine G DeClercq
- Center for Regenerative Sports Medicine, Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Alyson M Fiorentino
- Center for Regenerative Sports Medicine, Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | | | - Sara K Robinson
- Center for Regenerative Sports Medicine, Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Verena T Oberlohr
- Center for Regenerative Sports Medicine, Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Kaitlyn E Whitney
- Center for Regenerative Sports Medicine, Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | - Johnny Huard
- Center for Regenerative Sports Medicine, Steadman Philippon Research Institute, Vail, Colorado, USA
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Maillot C, Martellotto A, Demezon H, Harly E, Le Huec JC. Multiple Treatment Comparisons for Large and Massive Rotator Cuff Tears: A Network Meta-analysis. Clin J Sport Med 2021; 31:501-508. [PMID: 31743220 DOI: 10.1097/jsm.0000000000000786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 07/20/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND There is no consensus about the best choice between all the options available for large and massive rotator cuff tear (mRCTs) management. OBJECTIVE To determine the comparative effectiveness of current treatment options for management of large and mRCTs. DESIGN Network meta-analysis. SETTING We searched the Cochrane systematic reviews, MEDLINE and EMBASE databases for all trials of adults with large and mRCTs that report preoperative and postoperative functional scores after an intervention option. PATIENTS The network meta-analysis included 20 trials with 1233 patients with 37.24 months follow-up. INTERVENTIONS Eight treatment options for management of large and mRCTs were compared. MAIN OUTCOME MEASURES The primary effectiveness outcome was the functional score. RESULTS This meta-analysis did not show statistically significant differences between conservative, partial repair, patch or platelet rich plasma (PRP) augmentation, reverse total shoulder arthroplasty, and complete repair. Latissimus dorsi (LD) transfer was ranked first for effectiveness [standardized mean difference (SMD): 2.17, 0.28-4.07] and debridement ranked last (SMD: -2.15, -3.13 to -1.17). CONCLUSIONS Latissimus dorsi transfer seems to be most effective for management of large and mRCTs, although some heterogeneity was observed in this network meta-analysis of full text reports. The choice of the operating technique depends on the patient's general health status and his expectations. When a decision has been reached to perform surgery, a repair, even if partial, should be attempted. Procedures involving biologic augmentation (eg, PRP) seem to convey no additional benefit while introducing more risk. Debridement alone should be avoided.
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Affiliation(s)
- Cédric Maillot
- Department of Orthopaedics and Spine Surgery, Pellegrin Hospital, Bordeaux, France
- Department of Orthopedics Surgery, University Hospital of South Reunion Island, Reunion , France
| | - Alice Martellotto
- Department of Orthopedic Surgery, Mercy Hospital, Metz, France. ; and
| | - Hugues Demezon
- Department of Orthopaedics and Spine Surgery, Pellegrin Hospital, Bordeaux, France
| | - Edouard Harly
- Department of Orthopaedics and Spine Surgery, Pellegrin Hospital, Bordeaux, France
| | - Jean-Charles Le Huec
- Department of Orthopaedics and Spine Surgery, Pellegrin Hospital, Bordeaux, France
- Department of Orthopedic Surgery, Mercy Hospital, Metz, France. ; and
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Parisien RL, Ehlers C, Cusano A, Tornetta P, Li X, Wang D. The Statistical Fragility of Platelet-Rich Plasma in Rotator Cuff Surgery: A Systematic Review and Meta-analysis. Am J Sports Med 2021; 49:3437-3442. [PMID: 33646884 DOI: 10.1177/0363546521989976] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The practice of evidence-based medicine relies on objective data to guide clinical decision-making with specific statistical thresholds conveying study significance. PURPOSE To determine the utility of applying the fragility index (FI) and the fragility quotient (FQ) analysis to randomized controlled trials (RCTs) evaluating the utilization of platelet-rich plasma (PRP) in rotator cuff repairs (RCRs). STUDY DESIGN Systematic review and meta-analysis. METHODS RCTs pertaining to the utilization of PRP in surgical RCRs published in 13 peer-reviewed journals from 2000 to 2020 were evaluated. The FI was determined by manipulating each reported outcome event until a reversal of significance was appreciated. The associated FQ was determined by dividing the FI by the sample size. RESULTS Of the 9746 studies screened, 19 RCTs were ultimately included for analysis. The overall FI incorporating all 19 RCTs was only 4, suggesting that the reversal of only 4 events is required to change study significance. The associated FQ was determined as 0.092. Of the 43 outcome events reporting lost to follow-up data, 13 (30.2%) represented lost to follow-up >4. CONCLUSION Our analysis suggests that RCTs evaluating PRP for surgical RCRs may lack statistical stability with only a few outcome events required to alter trial significance. Therefore, we recommend the reporting of an FI and an FQ in conjunction with P value analysis to carefully interpret the integrity of statistical stability in future comparative trials. CLINICAL RELEVANCE Clinical decisions are often informed by statistically significant results. Thus, a true understanding of the robustness of the statistical findings informing clinical decision-making is of critical importance.
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Affiliation(s)
| | - Cooper Ehlers
- Georgetown University School of Medicine, Washington, DC, USA
| | | | - Paul Tornetta
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Xinning Li
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Dean Wang
- University of California at Irvine, Irvine, California, USA
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Foo GL, Knudsen JS, Bacon CJ, Mei-Dan O, McConkey MO, Brick MJ. Peri-operative platelet-rich plasma in arthroscopic femoroacetabular impingement surgery: a randomized controlled trial. J Hip Preserv Surg 2021; 8:14-21. [PMID: 34567596 PMCID: PMC8460155 DOI: 10.1093/jhps/hnab001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
This study aimed to determine whether the addition of platelet-rich plasma (PRP) during hip arthroscopy improves functional outcomes in femoroacetabular impingement (FAI) surgery. This was a prospective randomized single-blinded trial of arthroscopic hip patients aged between 16 and 50 years with a diagnosis of FAI conducted at a single centre. Patients with any previous hip surgery and significant osteoarthritic changes (Tonnis grade > 2) were excluded. Before surgery, patients were randomly assigned to receive either a PRP injection or a saline placebo. Efficacy was evaluated at 6 months, 1 year and 2 years post-surgery using patient-reported outcomes. The short version International Hip Outcome Tool (iHOT12) was the primary outcome. Recruited patients (n = 113) were aged 36.0 ± 10.5 (mean ± standard deviation) years and 56% male. At baseline, iHOT12 scores of the PRP (mean 43.8 ± 22.4) and placebo groups (mean 45.2 ± 21.5) were similar. At a minimum follow-up of 2 years, both groups had improved iHOT12 scores (PRP: mean 83.6 ± 13.4, control: mean 77.1 ± 23.3), with no significant difference in change between the two groups (P = 0.19). There were no significant group differences for the change in Non-Arthritic Hip and Hip Disability and Osteoarthritis Outcome Score—Shortform scores between the two groups (P = 0.22 and 0.46, respectively). The present study does not support the peri-operative use of PRP in arthroscopic surgery for FAI for mid-term improvement. There were no significant differences in outcome between PRP and placebo groups at 2-year minimum follow-up after surgery.
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Affiliation(s)
- Gen Lin Foo
- Orthosports North Harbour Ltd., AUT Millenium, 17 Antares Place, Rosedale 0632, New Zealand
| | - Joshua Sapong Knudsen
- New Zealand Orthopaedic Association, Level 12, Ranchhod Tower, 39, The Terrace, Wellington 6011, New Zealand
| | - Catherine Jane Bacon
- Orthosports North Harbour Ltd. & School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Omer Mei-Dan
- Division of Sports Medicine and Hip Preservation, Department of Orthopaedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Mark Owen McConkey
- Division of Arthroscopic, Reconstructive Surgery and Joint Preservation, Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Matthew John Brick
- Orthosports North Harbour Ltd., AUT Millenium , 17 Antares Place, Rosedale 0632, New Zealand
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Longo UG, Carnevale A, Piergentili I, Berton A, Candela V, Schena E, Denaro V. Retear rates after rotator cuff surgery: a systematic review and meta-analysis. BMC Musculoskelet Disord 2021; 22:749. [PMID: 34465332 PMCID: PMC8408924 DOI: 10.1186/s12891-021-04634-6] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 06/10/2021] [Indexed: 01/01/2023] Open
Abstract
Background Rotator cuff retear (RCR) is one of the main postoperative drawbacks. RCR can be considered a multifactorial issue, which causes are related either to biological than biomechanical factors. The aim of this study was to define the incidence of RCR after surgical treatment at different time points and to identify the main factors influencing the postoperative rotator cuff (RC) healing. Methods A systematic review and meta-analysis were performed following the PRISMA guidelines. A comprehensive search of the literature was carried out in July 2020, using PubMed and Cochrane Library databases. Only level 1 and 2 clinical evidence studies were included. Studies were included if patients with preoperative repairable full-thickness RC tears were treated surgically, and if studies reported postoperative RCR confirmed by imaging diagnostic. The association between timing of retear and follow-up time points were investigated using an inverse-variance method of pooling data. A subgroup meta-analysis was performed using the DerSimonian and Laird method for the estimation of the between-study variance, i.e., τ2. The association between retear rate after surgery and patients’ age, preoperative tear size, fatty infiltration, postoperative rehabilitation protocol, surgical techniques, and RC repairs was determined by expressing the effect measure in terms of odds ratio (OR) with 95% confidence interval (CI). The Mantel-Haenszel method with 95% CIs was used. Results Thirty-one articles were included in this study. The percentage of RCR after surgery was 15% at 3 months follow-up, 21% at 3–6 months follow-up, 16% at 6–12 months follow-up, 21% at 12–24 months follow-up, 16% at follow-up longer than 24 months. The main factors influencing RC healing are both patient-related (i.e., age, larger tear size, fatty infiltration) and not patient-related (i.e., postoperative rehabilitation protocol, surgical techniques, and procedures). Conclusions Postoperative RC healing is influenced by patient-related and non-patient-related factors. Further high-level clinical studies are needed to provide highly relevant clinical results. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04634-6.
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Affiliation(s)
- Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Álvaro del Portillo, 200, Trigoria, 00128, Rome, Italy.
| | - Arianna Carnevale
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Álvaro del Portillo, 200, Trigoria, 00128, Rome, Italy.,Unit of Measurements and Biomedical Instrumentation, Campus Bio-Medico University, Via Álvaro del Portillo, 21, 00128, Rome, Italy
| | - Ilaria Piergentili
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Álvaro del Portillo, 200, Trigoria, 00128, Rome, Italy
| | - Alessandra Berton
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Álvaro del Portillo, 200, Trigoria, 00128, Rome, Italy
| | - Vincenzo Candela
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Álvaro del Portillo, 200, Trigoria, 00128, Rome, Italy
| | - Emiliano Schena
- Unit of Measurements and Biomedical Instrumentation, Campus Bio-Medico University, Via Álvaro del Portillo, 21, 00128, Rome, Italy
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Álvaro del Portillo, 200, Trigoria, 00128, Rome, Italy
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Ryan JM, Imbergamo C, Sudah S, Kirchner G, Greenberg P, Monica J, Gatt C. Platelet-Rich Product Supplementation in Rotator Cuff Repair Reduces Retear Rates and Improves Clinical Outcomes: A Meta-analysis of Randomized Controlled Trials. Arthroscopy 2021; 37:2608-2624. [PMID: 33744318 PMCID: PMC8349828 DOI: 10.1016/j.arthro.2021.03.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 03/01/2021] [Accepted: 03/05/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to conduct a comprehensive systematic review and meta-analysis to investigate the clinical and imaging outcomes of all 4 types of platelet-rich therapies (pure platelet-rich plasma [P-PRP], leukocyte and platelet-rich plasma, pure platelet-rich fibrin, and leukocyte and platelet-rich fibrin) in rotator cuff repairs. METHODS A systematic literature search was performed to identify rotator cuff tears comparing any of the 4 types of platelet-rich products (PRP) to a control in rotator cuff repair. Data extracted from the studies included retear rates diagnosed with imaging studies, as well as outcome scores such as Constant, American Shoulder and Elbow Surgeons (ASES), University of California Los Angeles (UCLA), Simple Shoulder Test (SST), and visual analog scale (VAS). Meta-analyses compared postoperative outcome scores and retear rates between the control and study groups. RESULTS Seventeen studies were included in the meta-analysis. When pooling data from all studies, retear rate for the treatment group was 19.3%, compared to 25.4% for the control group (odds ratio [OR] 0.59, P = .0037). When stratified based on PRP type, only P-PRP resulted in a significant reduction in retear rate (OR 0.26, P = .0005). Overall, treatment with PRP significantly improved Constant scores when compared to controls (mean difference [MD] 2.41, P =.0027), as well as VAS scores (MD -0.12, P = .0014), and SST scores (MD 0.41, P = .0126). There was no significant difference in ASES scores (MD 0.37, P = .7762) or UCLA scores (MD 0.76, P =0.2447) between treatment and controls when pooling data from all studies. CONCLUSIONS This analysis demonstrates significant reductions in retear rates when rotator cuff repair is augmented with PRP. P-PRP appears to be the most effective formulation, resulting in significantly improved retear rates and clinical outcome scores when compared with controls.
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Affiliation(s)
- James M Ryan
- Rutgers Robert Wood Johnson Medical School, New Brunswick,
NJ
| | - Casey Imbergamo
- Rutgers Robert Wood Johnson Medical School, New Brunswick,
NJ
| | | | | | | | - James Monica
- Rutgers Robert Wood Johnson Medical School, New Brunswick,
NJ
| | - Charles Gatt
- Rutgers Robert Wood Johnson Medical School, New Brunswick,
NJ
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40
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Xu W, Xue Q. Application of Platelet-Rich Plasma in Arthroscopic Rotator Cuff Repair: A Systematic Review and Meta-analysis. Orthop J Sports Med 2021; 9:23259671211016847. [PMID: 34345632 PMCID: PMC8283084 DOI: 10.1177/23259671211016847] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 02/03/2021] [Indexed: 12/17/2022] Open
Abstract
Background: It is unclear how and which factors affect the clinical efficacy of
platelet-rich plasma (PRP) applied during arthroscopic rotator cuff
repair. Purpose: To evaluate the clinical efficacy of PRP for arthroscopic repair of
full-thickness rotator cuff tear and investigate the factors that affect its
clinical efficacy. Study Design: Systematic review; Level of evidence, 1. Methods: We searched Cochrane Library, EMBASE, MEDLINE, and OVID to identify
randomized controlled trials (RCTs) of patients who received PRP treatment
and arthroscopic rotator cuff repair (PRP group) versus controls (no-PRP
group). The primary outcomes included retear rate, Constant-Murley score,
University of California Los Angeles (UCLA) score, short-term American
Shoulder and Elbow Surgeons (ASES) score, visual analog scale (VAS) score
for pain, and adverse events. Results: A total of 14 RCTs were included in this systematic review. Significant
improvement in Constant-Murley, UCLA, and VAS pain scores were found in the
PRP group during short-term, midterm, and long-term follow-up. The PRP group
had a significantly decreased retear rate (risk ratio [RR], 0.57 [95% CI,
0.42 to 0.78]; P = .0003), especially for long-term
follow-up (RR, 0.38 [95% CI, 0.17 to 0.83]; P = .02), large
to massive tears (RR, 0.58 [95% CI, 0.42 to 0.80]; P =
.0008), use of leukocyte-poor PRP (RR, 0.50 [95% CI, 0.33 to 0.76];
P = .001), and intraoperative application of PRP (RR,
0.57 [95% CI, 0.42 to 0.79]; P = .0007). No significant
difference between the 2 groups was found in the incidence of adverse events
(RR, 1.34 [95% CI, 0.83 to 2.15]; P = .23) or in ASES
scores at short-term follow-up (weighted mean difference, 1.04 [95% CI,
–3.10 to 5.19]; P = .62). Conclusion: The results of this review indicated that arthroscopic rotator cuff repair
with PRP significantly reduced the long-term retear rate and shoulder pain
and provided improved long-term shoulder function in patients.
Intraoperative application of PRP, use of leukocyte-poor plasma, and large
to massive tear size contributed to a significantly decreased retear rate
for rotator cuff repair combined with PRP.
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Affiliation(s)
- Wennan Xu
- Orthopaedics Department, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Qingyun Xue
- Orthopaedics Department, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
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Checchia CS, Silva LAD, Sella GDV, Fregoneze M, Miyazaki AN. Current Options in Tendon Transfers for Irreparable Posterosuperior Rotator Cuff Tears. Rev Bras Ortop 2021; 56:281-290. [PMID: 34239191 PMCID: PMC8249074 DOI: 10.1055/s-0040-1709988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 01/10/2020] [Indexed: 10/28/2022] Open
Abstract
Massive irreparable posterosuperior rotator-cuff tears are debilitating lesions that usually require surgical treatment. Even though there is no consensus regarding the best surgical technique, tendinous transfers around the shoulder are the most commonly performed procedures. The latissimus dorsi tendon remains the most commonly used, but different modifications to the original technique have been shown to minimize complications and to improve functional results and satisfaction. Other techniques, such as the transfer of the lower trapezius tendon, are promising and should be considered, especially for patients with isolated loss of external rotation. The present paper is a literary review regarding tendon transfers for irreparable posterosuperior rotator-cuff tears.
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Affiliation(s)
- Caio Santos Checchia
- Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brasil
| | - Luciana Andrade da Silva
- Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brasil
| | - Guilherme do Val Sella
- Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brasil
| | - Marcelo Fregoneze
- Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brasil
| | - Alberto Naoki Miyazaki
- Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brasil
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Lee MJ, Yoon KS, Oh S, Shin S, Jo CH. Allogenic Pure Platelet-Rich Plasma Therapy for Adhesive Capsulitis: A Bed-to-Bench Study With Propensity Score Matching Using a Corticosteroid Control Group. Am J Sports Med 2021; 49:2309-2320. [PMID: 34166113 DOI: 10.1177/03635465211018636] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND While platelet-rich plasma (PRP) has been widely studied for musculoskeletal disorders, few studies to date have reported its use for adhesive capsulitis (AC). Fully characterized and standardized allogenic PRP may provide clues to solve the underlying mechanism of PRP with respect to synovial inflammation and thus may clarify its clinical indications. PURPOSE To clinically evaluate the safety and efficacy of a fully characterized pure PRP injection in patients with AC and to assess the effects of pure PRP on synoviocytes with or without inflammation in vitro. STUDY DESIGN Controlled laboratory study and cohort study; Level of evidence, 3. METHODS For the clinical analysis, a total of 15 patients with AC received an ultrasonography-guided intra-articular PRP injection and were observed for 6 months. Pain, range of motion (ROM), muscle strength, shoulder function, and overall satisfaction in the patients were evaluated using questionnaires at 1 week as well as at 1, 3, and 6 months after the PRP injection and results were compared with the results of a propensity score-matched control group that received a corticosteroid injection (40 mg triamcinolone acetonide). For the in vitro analysis, synoviocytes were cultured with or without interleukin-1β (IL-1β) and PRP. The gene expression of proinflammatory and anti-inflammatory cytokines as well as matrix enzymes and their inhibitors was evaluated. RESULTS At 6-month follow-up, pure PRP significantly decreased pain and improved ROM, muscle strength, and shoulder function to levels comparable with those after a corticosteroid injection. All pain values, strength measurements, and functional scores significantly improved up to 6 months in the PRP group, but these measures improved up to 3 months and then were decreased at 6 months in the corticosteroid group. ROM was significantly improved in the 2 groups at 6 months compared with baseline. Allogenic PRP did not cause adverse events. For the in vitro findings, PRP induced inflammation but significantly improved the IL 1β-induced synovial inflammatory condition by decreasing proinflammatory cytokines such as IL-1β, tumor necrosis factor-α, IL-6, cyclooxygenase-2, and microsomal prostaglandin E synthase-1 and decreased matrix enzymes (matrix metalloproteinase-1, -3, and -13 as well as a disintegrin and metalloproteinase with thrombospondin motifs-4 and -5) and further increasing anti-inflammatory cytokines such as vasoactive intestinal peptide. CONCLUSION This study showed that PRP decreased pain and improved shoulder ROM and function to an extent comparable with that of a corticosteroid in patients with AC. Allogenic pure PRP acted in a pleiotropic manner and decreased proinflammatory cytokines only in the inflammatory condition. CLINICAL RELEVANCE Allogenic PRP could be a treatment option for the inflammatory stage of AC.
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Affiliation(s)
- Min Ji Lee
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Translational Medicine, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kang Sup Yoon
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sohee Oh
- Department of Biostatistics, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sue Shin
- Department of Laboratory Medicine, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chris Hyunchul Jo
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Translational Medicine, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
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Hurley ET, Colasanti CA, Anil U, Luthringer TA, Alaia MJ, Campbell KA, Jazrawi LM, Strauss EJ. The Effect of Platelet-Rich Plasma Leukocyte Concentration on Arthroscopic Rotator Cuff Repair: A Network Meta-analysis of Randomized Controlled Trials. Am J Sports Med 2021; 49:2528-2535. [PMID: 33332160 DOI: 10.1177/0363546520975435] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND It is unclear whether leukocyte-poor (LP) or leukocyte-rich (LR) varieties of platelet-rich plasma (PRP) as an adjuvant to arthroscopic rotator cuff repair (ARCR) result in improved tendon healing rates. PURPOSE To perform a network meta-analysis of the randomized controlled trials in the literature to ascertain whether there is evidence to support the use of LP- or LR-PRP as an adjunct to ARCR. METHODS The literature search was based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Randomized controlled trials comparing LP- or LR-PRP with a control alongside ARCR were included. Clinical outcomes, including retears and functional outcomes, were compared using a frequentist approach to network meta-analysis, with statistical analysis performed using R. The treatment options were ranked using the P-score. RESULTS There were 13 studies (868 patients) included, with 9 studies comparing LP-PRP with a control and 4 studies comparing LR-PRP with a control. LP-PRP was found to significantly reduce the rate of retear and/or incomplete tendon healing after fixation, even among medium-large tears; it also improved outcomes on the visual analog scale for pain, Constant score, and University of California Los Angeles score. LP-PRP had the highest P-score for all treatment groups. LR-PRP did not result in any significant improvements over the control group, except for visual analog scale score for pain. However, post hoc analysis revealed that LP-PRP did not lead to significant improvements over LR-PRP in any category. CONCLUSION The current study demonstrates that LP-PRP reduces the rate of retear and/or incomplete tendon healing after ARCR and improves patient-reported outcomes as compared with a control. However, it is still unclear whether LP-PRP improves the tendon healing rate when compared with LR-PRP.
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Affiliation(s)
| | | | - Utkarsh Anil
- New York University Langone Health, New York, New York, USA
| | | | | | | | | | - Eric J Strauss
- New York University Langone Health, New York, New York, USA
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Villarreal-Villarreal GA, Simental-Mendía M, Garza-Borjón AE, Millán-Alanís JM, Vilchez-Cavazos F, Peña-Martínez VM, Acosta-Olivo CA. Double-Row Rotator Cuff Repair Enhanced With Platelet-Rich Therapy Reduces Retear Rate: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Arthroscopy 2021; 37:1937-1947.e1. [PMID: 33359156 DOI: 10.1016/j.arthro.2020.12.191] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 11/30/2020] [Accepted: 12/03/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess retear rates in arthroscopic double-row rotator cuff repair (double-row RCR) with and without platelet-rich therapy (PRT). METHODS Systematic review and meta-analysis of randomized controlled trials (RCTs). MEDLINE, Embase, and Scopus databases were searched for RCTs involving use of PRT exclusively in arthroscopic double-row RCR. A random-effects model and the generic inverse variance method were used for quantitative data synthesis. Heterogeneity was tested with the I2 statistic index. RESULTS The 9 RCTs included in the meta-analysis demonstrated a risk reduction of 49% for retears in patients receiving PRT (risk ratio [RR] 0.51; 95% confidence interval [CI] 0.35 to 0.76; P = .0008; I2 = 0%). Divided by tear sizes, retear risk reduction of 47% (RR 0.53; 95% CI 0.30 to 0.95; P = .03; I2 = 0%) was found in small to medium tears and 51% (RR 0.49; 95% CI 0.29 to 0.84; P = .009; I2 = 0%) in large to massive tears. Linked double-row RCR resulted in risk reduction of 51% for retears in comparison with nonlinked repairs. CONCLUSION Double-row RCR plus PRT significantly reduced retear rates in all sizes of rotator cuff tears. Linked double-row RCR and applying the PRT during the surgical procedure and in the tendon-bone interface reproduced the best outcomes. Clinically, all patients improved, and no statistically significant difference was seen in clinical and functional scores between the intervention groups. All patients achieved optimal values for patient-reported outcomes measures. LEVEL OF EVIDENCE I, systematic review and meta-analysis of level I studies.
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Affiliation(s)
- Gregorio Alejandro Villarreal-Villarreal
- Orthopedics and Traumatology Service, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Mario Simental-Mendía
- Orthopedics and Traumatology Service, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Abiel Eugenio Garza-Borjón
- Orthopedics and Traumatology Service, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Juan Manuel Millán-Alanís
- Facultad de Medicina, Universidad Autonoma de Nuevo Leon, Plataforma Invest-KER Unit Mexico, Monterrey, Mexico
| | - Félix Vilchez-Cavazos
- Orthopedics and Traumatology Service, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Víctor Manuel Peña-Martínez
- Orthopedics and Traumatology Service, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Carlos Alberto Acosta-Olivo
- Orthopedics and Traumatology Service, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico.
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Abstract
The aim of this article was to synopsize platelet-rich plasma (PRP) use in musculoskeletal pathologies through evidence-based assessment of the preparation, classification, mechanism of action and applications of PRP, thereby answering which PRP type is best for each clinical indication. The literature search was performed using Medline, EMBASE and Cochrane Reviews databases for papers containing the key terms “platelet-rich plasma” AND “orthopaedics” AND (“classification” OR “mechanism of action” OR “preparation” OR “clinical application”). Generated papers were evaluated for pertinence in following areas: preparation, classification, mechanism of action, clinical application within orthopaedics. Non-English papers were excluded. Included studies were evaluated for quality. Sixty studies were included in our review. There are many commercial PRP preparation kits with differing component concentrations. There is no consensus on optimal component concentrations. Multiple PRP classifications exist but none have been validated. Platelet-rich plasma acts via growth factors (GFs) released from α-granules within platelets. Growth factors have been shown to be beneficial in healing. Grossly elevated concentrations of GFs may have inhibitory effects on healing. Multiple systematic reviews show efficacy of PRP in tendinopathies, early osteoarthritis, acute muscle injuries and in combination with rotator cuff repair and anterior cruciate ligament reconstruction. The literature suggests leukocyte-rich PRP (L-PRP) is more beneficial in tendinopathies and pure PRP (P-PRP) is more beneficial in cartilage pathology. However, different PRP preparations have not been directly compared in any pathology. Classification of PRP type is frequently not stated in research. Standardization of PRP research parameters is needed to streamline findings and generate clear indications for PRP types to yield maximum clinical benefit. Cite this article: EFORT Open Rev 2021;6:225-235. DOI: 10.1302/2058-5241.6.200017
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Affiliation(s)
- Thomas Collins
- Trauma & Orthopaedics, Wythenshawe Hospital, Wythenshawe, UK
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Zhao D, Han YH, Pan JK, Yang WY, Zeng LF, Liang GH, Liu J. The clinical efficacy of leukocyte-poor platelet-rich plasma in arthroscopic rotator cuff repair: a meta-analysis of randomized controlled trials. J Shoulder Elbow Surg 2021; 30:918-928. [PMID: 33220417 DOI: 10.1016/j.jse.2020.10.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 10/07/2020] [Accepted: 10/15/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND The efficacy of platelet-rich plasma (PRP) in the arthroscopic treatment of rotator cuff injury has been reported in the literature. However, conclusions have been inconsistent and more often related to differences in the types of PRP used. Therefore, to minimize these differences, we performed a meta-analysis of only studies investigating leukocyte-poor PRP to evaluate whether PRP promotes and improves the effects of arthroscopic rotator cuff repair. METHODS A comprehensive search of the PubMed, Embase, and Cochrane Library databases was conducted to evaluate the efficacy of leukocyte-poor PRP in arthroscopic rotator cuff repair. The available data were extracted, and the methodologic quality of the included studies was evaluated by the Cochrane risk-of-bias assessment tool. RESULTS In total, 10 randomized controlled trials involving 742 patients were included. The results of the meta-analysis showed that treatment with leukocyte-poor PRP performed better than the control treatment in relieving postoperative pain in the short-term (mean difference [MD], -0.57; 95% confidence interval [CI], -0.79 to -0.35; P < .0001) and medium- and long-term (MD, -0.18; 95% CI, -0.34 to -0.03; P = .02) follow-up groups. However, the changes in the MD in the visual analog scale score were below the minimal clinically important difference. Regarding the Constant shoulder (MD, 3.35; 95% CI, 1.68-5.02; P < .0001) and University of California, Los Angeles (MD, 1.73; 95% CI, 0.94-2.52; P < .0001) scores, statistically significant differences were found in favor of leukocyte-poor PRP over the control treatment. However, the changes in the MD in both the Constant and University of California, Los Angeles scores were below the minimal clinically important difference. Moreover, during medium- and long-term follow-up, the retear rate in the leukocyte-poor PRP group was lower than that in the control group regardless of the rotator cuff tear size (small and medium [<3 cm] [risk ratio (RR), 0.64; 95% CI, 0.43-0.97; P = .03] vs. medium and large [>3 cm] [RR, 0.51; 95% CI, 0.34-0.77; P = .001]) and surgical repair method (single-row repair [RR, 0.61; 95% CI, 0.43-0.87; P = .007] vs. double-row suture bridge repair [RR, 0.57; 95% CI, 0.38-0.84; P = .005]). CONCLUSION According to our study, leukocyte-poor PRP can significantly reduce the postoperative retear rate in the medium and long term regardless of the tear size and the method used for rotator cuff repair. However, the use of leukocyte-poor PRP failed to show clinically meaningful effects in terms of postoperative pain and patient-reported outcomes.
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Affiliation(s)
- Di Zhao
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yan-Hong Han
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jian-Ke Pan
- Department of Orthopedics, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wei-Yi Yang
- Department of Orthopedics, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ling-Feng Zeng
- Department of Orthopedics, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China; Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Gui-Hong Liang
- Department of Orthopedics, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China; Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Jun Liu
- Department of Orthopedics, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China; Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China.
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47
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A narrative review of platelet-rich plasma (PRP) in reproductive medicine. J Assist Reprod Genet 2021; 38:1003-1012. [PMID: 33723748 DOI: 10.1007/s10815-021-02146-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/07/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Platelet-rich plasma (PRP) has become a novel treatment in various aspects of medicine including orthopedics, cardiothoracic surgery, plastic surgery, dermatology, dentistry, and diabetic wound healing. PRP is now starting to become an area of interest in reproductive medicine more specifically focusing on infertility. Poor ovarian reserve, menopause, premature ovarian failure, and thin endometrium have been the main areas of research. The aim of this article is to review the existing literature on the effects of autologous PRP in reproductive medicine providing a summation of the current studies and assessing the need for additional research. METHODS A literature search is performed using PubMed, MEDLINE, and CINAHL Plus to identify studies focusing on the use of PRP therapy in reproductive medicine. Articles were divided into 3 categories: PRP in thin lining, PRP in poor ovarian reserve, and PRP in recurrent implantation failure. RESULTS In women with thin endometrium, the literature shows an increase in endometrial thickness and increase in chemical and clinical pregnancy rates following autologous PRP therapy. In women with poor ovarian reserve, autologous intraovarian PRP therapy increased anti-Mullerian hormone (AMH) levels and decreased follicle-stimulating hormone (FSH), with a trend toward increasing clinical and live birth rates. This trend was also noted in women with recurrent implantation failure. CONCLUSIONS Limited literature shows promise in increasing endometrial thickness, increasing AMH, and decreasing FSH levels, as well as increasing chemical and clinical pregnancy rates. The lack of standardization of PRP preparation along with the lack of large randomized controlled trials needs to be addressed in future studies. Until definitive large RCTs are available, PRP use should be considered experimental.
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Neyton L, Gossing L, Gasbarro G, Kirsch JM. Modified L'Episcopo tendon transfer for isolated loss of active external rotation. J Shoulder Elbow Surg 2020; 29:2587-2594. [PMID: 32669198 DOI: 10.1016/j.jse.2020.03.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patients with isolated loss of active external rotation (ILER) but preserved active forward elevation have recently been identified as a rare and distinct clinical entity. The modified L'Episcopo procedure attempts to restore horizontal muscle balance and restore active external rotation. METHODS A retrospective study was performed for all patients with ILER and preserved forward elevation with Hamada stage ≤2 changes undergoing the modified L'Episcopo tendon transfer. Preoperative rotator cuff fatty infiltration and morphology was reported. Clinical, radiographic, and functional outcomes were recorded preoperatively and compared to postoperative outcomes at a minimum of 24 months' follow-up. RESULTS Nine patients (8 male, 1 female) with a mean age of 58.4 years (range, 51-67 years) were evaluated at a mean follow-up of 64.3 months (range, 24-126 months). Significant improvement was demonstrated in active external rotation with the arm at the side (mean increase of 47°; range, 30°-60°, P = .004) and at 90° abduction (mean increase of 41°; range, 20°-70°, P = .004). The mean Constant score and pain score significantly improved at final follow-up (P = .004). All patients were either very satisfied or satisfied, with a mean subjective shoulder value of 74% (range, 60%-99%). CONCLUSION In appropriately selected patients with ILER and preserved active forward elevation, the modified L'Episcopo procedure can restore horizontal muscle balance and produce significant improvements in active external rotation, Constant score, and pain.
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Affiliation(s)
- Lionel Neyton
- Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France.
| | - Louis Gossing
- Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
| | - Gregory Gasbarro
- Orthopaedic Specialty Hospital, Mercy Medical Center, Baltimore, MD, USA
| | - Jacob M Kirsch
- Departments of Orthopaedic Surgery & Shoulder/Elbow Surgery, The Rothman Institute-Thomas Jefferson, Philadelphia, PA, USA
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Anz HA, Ahmad HA, Kozemchak AM, Rao M, Warth RJ, Harner CD. Funding sources are under-reported in randomised clinical trials of biological treatments in sports medicine: a systematic review. J ISAKOS 2020. [DOI: 10.1136/jisakos-2020-000452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Goldenberg BT, Lacheta L, Dekker TJ, Spratt JD, Nolte PC, Millett PJ. Biologics to Improve Healing in Large and Massive Rotator Cuff Tears: A Critical Review. Orthop Res Rev 2020; 12:151-160. [PMID: 33116954 PMCID: PMC7568683 DOI: 10.2147/orr.s260657] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/24/2020] [Indexed: 01/08/2023] Open
Abstract
Large and massive rotator cuff tears have the highest risk of retear. Common biologic modalities that can potentially reduce the retear rate and improve healing include platelet-rich plasma (PRP), scaffolds, and mesenchymal stem cells (MSCs). PRP has been studied for its role in improving rotator cuff healing and results of randomized controlled trials and meta-analyses show mixed results. Most studies in large and massivge tears show that PRP decreases the retear rate, but the connection between structural integrity and clinical outcomes is still unknown. Extracellular matrix (ECM) and synthetic scaffolds can increase healing in augmentation and bridging repair. Acellular dermal allografts have shown better healing rates and outcomes than xenografts in meta-analyses. Synthetic scaffolds augmented with bone marrow-derived stem cells have only been studied in vitro but are promising for the combination of mechanical stability and induction of a biological response. Superior capsule reconstruction is an exciting type of interposition graft reconstruction that has shown favorable early clinical outcomes for large and massive tears. Bone marrow-derived stem cells and adipose-derived stem cells improve the biomechanical characteristics of tendon repair and enhance the histological findings of the healing process in animal studies. However, evidence from human studies is lacking, especially in patients with large and massive tears. In summary, there are many biological options to augment rotator cuff repair in patients with large and massive tears. Due to mixed results and a lack of standardization in high-quality studies, we cannot recommend PRP at this time as an adjunct to rotator cuff repair. Both ECM and synthetic scaffolds, as well as SCR, can be used, especially in situations where native tendon is compromised, and additional mechanical augmentation is needed. Stem cells have been the least studied to date, so it is difficult to give recommendations for or against their use at this time.
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Affiliation(s)
| | - Lucca Lacheta
- Steadman-Philippon Research Institute, Vail, CO 81657, USA.,Center for Musculoskeletal Surgery, Charitè Universitaetsmedizin Berlin, Berlin, Germany
| | - Travis J Dekker
- Department of Orthopaedic Surgery, Eglin Air Force Base, Elgin, FL, USA
| | - James D Spratt
- Steadman-Philippon Research Institute, Vail, CO 81657, USA
| | - Philip C Nolte
- Steadman-Philippon Research Institute, Vail, CO 81657, USA
| | - Peter J Millett
- Steadman-Philippon Research Institute, Vail, CO 81657, USA.,The Steadman Clinic, Vail, CO 81657, USA
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