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MUSCULOSKELETAL SURGERY

Erschienen in:

01.12.2016 | Original Article

Platelet-rich plasma supplementation in arthroscopic repair of full-thickness rotator cuff tears: a randomized clinical trial

verfasst von: R. D’Ambrosi, F. Palumbo, A. Paronzini, V. Ragone, R. M. Facchini

Erschienen in: MUSCULOSKELETAL SURGERY | Sonderheft 1/2016

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Abstract

Background

Results on the effectiveness of PRP supplementation in arthroscopic rotator cuff repair are conflicting, making it difficult to draw definitive conclusions.

Methods

This was a prospective, randomized, and double-blind study with two groups of 20 patients each (PRP group and control group). Degenerative supraspinatus full-thickness tears grade C2–C3 were subjected to arthroscopic repair; PRP supplementation was given to patients in the PRP group. The outcomes were assessed by DASH, Constant scales, and ultrasound before and 6 months after surgery. Pain measured by VAS was evaluated preoperatively and 7 and 30 days after surgery.

Results

The two groups did not differ significantly by age, sex, and dominance of the affected side. In all surgical procedures, a long head of the biceps tenotomy and single-row repair were performed. The preoperative VAS was 5.6 ± 2.4 in PRP group and 6.4 ± 1.5 in the control group (p > 0.05). The group supplemented with PRP reported a VAS significantly better in the first week (2.5 ± 1.9 vs 5.3 ± 2.1, p < 0.05) and during the first month after surgery (1.5 ± 1.0 vs 3.2 ± 1.7, p < 0.05) compared to the control group. The preoperative Constant and DASH scores were 39.95 ± 12 and 51 ± 15.2, respectively, in the PRP group and 41 ± 11 (p > 0.05) and 45 ± 12.6 (p > 0.05) in the control group. The average Constant score improved significantly after 6 months to 81 ± 11.2 (p < 0.05) in the PRP group and 78.5 ± 9 (p < 0.05) in the control group. No differences were noted between the two groups (p > 0.05). The DASH score after 6 months was 17.4 ± 8 (p < 0.05) for the treatment group (the PRP group) and 21 ± 8.4 (p < 0.05) for the control group. No statistically significant differences were found as regards the DASH score in the two groups after 6 months (p > 0.05). The two groups showed no differences in the ultrasound evaluation after 6 months either. No re-ruptures occurred in either group.

Conclusions

PRP leads to a reduction in pain during a short-term follow-up. Pain reduction allows for a more rapid recovery of mobilization and improvement in functionality.

Level of evidence

Randomized controlled trial, Level of evidence, 1.

Teunis T, Lubberts B, Reilly BT, Ring D (2014) A systematic review and pooled analysis of the prevalence of rotator cuff disease with increasing age. J Shoulder Elbow Surg 23(12):1913–1921CrossRefPubMed

Gumina S, Carbone S, Campagna V, Candela V, Sacchetti FM, Giannicola G (2013) The impact of aging on rotator cuff tear size. Musculoskelet Surg 97(Suppl 1):69–72CrossRefPubMed

Lichtenberg S, Liem D, Magosch P, Habermeyer P (2006) Influence of tendon healing after arthroscopic rotator cuff repair on clinical outcome using single-row Mason-Allen suture technique: a prospective, MRI controlled study. Knee Surg Sports Traumatol Arthrosc 14(11):1200–1206CrossRefPubMed

Burkhart SS, Danaceau SM, Pearce CE Jr (2001) Arthroscopic rotator cuff repair: analysis of results by tear size and by repair technique-margin convergence versus direct tendon-to-bone repair. Arthroscopy 17(9):905–912CrossRefPubMed

Cheung EV, Silverio L, Sperling JW (2010) Strategies in biologic augmentation of rotator cuff repair: a review. Clin Orthop Relat Res 468(6):1476–1484CrossRefPubMedPubMedCentral

Castagna A, Cesari E, Gigante A, Conti M, Garofalo R (2013) Metalloproteases and their inhibitors are altered in both torn and intact rotator cuff tendons. Musculoskelet Surg 97(Suppl 1):39–47CrossRefPubMed

Hein J, Reilly JM, Chae J, Maerz T, Anderson K (2015) Retear rates after arthroscopic single-row, double-row, and suture bridge rotator cuff repair at a minimum of 1 year of imaging follow-up: a systematic review. Arthroscopy 31(11):2274–2281CrossRefPubMed

Randelli P, Randelli F, Ragone V, Menon A, D’Ambrosi R, Cucchi D, Cabitza P, Banfi G (2014) Regenerative medicine in rotator cuff injuries. Biomed Res Int 2014:129515CrossRefPubMedPubMedCentral

Everts PA, Knape JT, Weibrich G, Schönberger JP, Hoffmann J, Overdevest EP, Box HA, van Zundert A (2006) Platelet-rich plasma and platelet gel: a review. J Extra Corpor Technol 38(2):174–187PubMedPubMedCentral

10.

Randelli P, Arrigoni P, Ragone V, Aliprandi A, Cabitza P (2011) Platelet rich plasma in arthroscopic rotator cuff repair: a prospective RCT study, 2-year follow-up. J Shoulder Elbow Surg 20(4):518–528CrossRefPubMed

11.

Snyder SJ, Pachelli AF, Del Pizzo W, Friedman MJ, Ferkel RD, Pattee G (1991) Partial thickness rotator cuff tears: results of arthroscopic treatment. Arthroscopy 7(1):1–7CrossRefPubMed

12.

Garofalo R, Conti M, Notarnicola A, Maradei L, Giardella A, Castagna A (2010) Effects of one-month continuous passive motion after arthroscopic rotator cuff repair: results at 1-year follow-up of a prospective randomized study. Musculoskelet Surg 94(Suppl 1):S79–S83CrossRefPubMed

13.

Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164

14.

Hudak PL, Amadio PC, Bombardier C (1996) Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med 29(6):602–6088. Erratum in Am J Ind Med 30(3):372

15.

Jo CH, Kim JE, Yoon KS, Shin S (2012) Platelet-rich plasma stimulates cell proliferation and enhances matrix gene expression and synthesis in tenocytes from human rotator cuff tendons with degenerative tears. Am J Sports Med 40(5):1035–1045CrossRefPubMed

16.

Ersen A, Demirhan M, Atalar AC, Kapicioğlu M, Baysal G (2014) Platelet-rich plasma for enhancing surgical rotator cuff repair: evaluation and comparison of two application methods in a rat model. Arch Orthop Trauma Surg 134(3):405–411CrossRefPubMed

17.

Asfaha S, Cenac N, Houle S, Altier C, Papez MD, Nguyen C, Steinhoff M, Chapman K, Zamponi GW, Vergnolle N (2007) Protease-activated receptor-4: a novel mechanism of inflammatory pain modulation. Br J Pharmacol 150(2):176–185CrossRefPubMed

18.

Arrigoni P, Ragone V, D’Ambrosi R, Denard P, Randelli F, Banfi G, Cabitza P, Randelli P (2014) Improving the accuracy of the preoperative diagnosis of long head of the biceps pathology: the biceps resisted flexion test. Joints 2(2):54–58PubMedPubMedCentral

19.

Zappia M, Reginelli A, Russo A, D’Agosto GF, Di Pietto F, Genovese EA, Coppolino F, Brunese L (2013) Long head of the biceps tendon and rotator interval. Musculoskelet Surg 97(Suppl 2):S99–S108CrossRefPubMed

20.

Castricini R, Longo UG, De Benedetto M, Panfoli N, Pirani P, Zini R, Maffulli N, Denaro V (2011) Platelet-rich plasma augmentation for arthroscopic rotator cuff repair: a randomized controlled trial. Am J Sports Med 39(2):258–265CrossRefPubMed

21.

Barber FA, Hrnack SA, Snyder SJ, Hapa O (2011) Rotator cuff repair healing influenced by platelet-rich plasma construct augmentation. Arthroscopy 27(8):1029–1035CrossRefPubMed

22.

Bergeson AG, Tashjian RZ, Greis PE, Crim J, Stoddard GJ, Burks RT (2012) Effects of platelet-rich fibrin matrix on repair integrity of at-risk rotator cuff tears. Am J Sports Med 40(2):286–293CrossRefPubMed

23.

Jo CH, Kim JE, Yoon KS, Lee JH, Kang SB, Lee JH, Han HS, Rhee SH, Shin S (2011) Does platelet-rich plasma accelerate recovery after rotator cuff repair? A prospective cohort study. Am J Sports Med 39(10):2082–2090CrossRefPubMed

24.

Rodeo SA, Delos D, Williams RJ, Adler RS, Pearle A, Warren RF (2012) The effect of platelet-rich fibrin matrix on rotator cuff tendon healing: a prospective, randomized clinical study. Am J Sports Med 40(6):1234–1241CrossRefPubMed

25.

Gumina S, Campagna V, Ferrazza G, Giannicola G, Fratalocchi F, Milani A, Postacchini F (2012) Use of platelet-leukocyte membrane in arthroscopic repair of large rotator cuff tears: a prospective randomized study. J Bone Joint Surg Am 94(15):1345–1352CrossRefPubMed

26.

Weber SC, Kauffman JI, Parise C, Weber SJ, Katz SD (2013) Platelet-rich fibrin matrix in the management of arthroscopic repair of the rotator cuff: a prospective, randomized, double-blinded study. Am J Sports Med 41(2):263–270CrossRefPubMed

27.

Charousset C, Zaoui A, Bellaïche L, Piterman M (2014) Does autologous leukocyte-platelet-rich plasma improve tendon healing in arthroscopic repair of large or massive rotator cuff tears? Arthroscopy 30(4):428–435CrossRefPubMed

28.

Malavolta EA, Gracitelli ME, Ferreira Neto AA, Assunção JH, Bordalo-Rodrigues M, de Camargo OP (2014) Platelet-rich plasma in rotator cuff repair: a prospective randomized study. Am J Sports Med 42(10):2446–2454CrossRefPubMed

29.

Carr AJ, Murphy R, Dakin SG, Rombach I, Wheway K, Watkins B, Franklin SL (2015) Platelet-rich plasma injection with arthroscopic acromioplasty for chronic rotator cuff tendinopathy: a randomized controlled trial. Am J Sports Med 43(12):2891–2897CrossRefPubMed

30.

Zumstein MA, Rumian A, Lesbats V, Schaer M, Boileau P (2014) Increased vascularization during early healing after biologic augmentation in repair of chronic rotator cuff tears using autologous leukocyte- and platelet-rich fibrin (L-PRF): a prospective randomized controlled pilot trial. J Shoulder Elbow Surg 23(1):3–12CrossRefPubMed

31.

Hak A, Rajaratnam K, Ayeni OR, Moro J, Peterson D, Sprague S, Bhandari M (2015) A double-blinded placebo randomized controlled trial evaluating short-term efficacy of platelet-rich plasma in reducing postoperative pain after arthroscopic rotator cuff repair: a pilot study. Sports Health 7(1):58–66CrossRefPubMedPubMedCentral

32.

Didden K, Leirs G, Aerts P (2010) The impact of the Belgian workers’ compensation system on return to work after rotator cuff surgery. Acta Orthop Belg 76:592–597PubMed

33.

Collin P, Abdullah A, Kherad O, Gain S, Denard PJ, Lädermann A (2015) Prospective evaluation of clinical and radiologic factors predicting return to activity within 6 months after arthroscopic rotator cuff repair. J Shoulder Elbow Surg 24(3):439–445CrossRefPubMed

34.

Collin P, Yoshida M, Delarue A, Lucas C, Jossaume T, Lädermann A (2015) French Society for Shoulder and Elbow (SOFEC). Evaluating postoperative rotator cuff healing: prospective comparison of MRI and ultrasound. Orthop Traumatol Surg Res. 101(6 Suppl):S265–S268CrossRefPubMed

35.

Zumstein MA, Rumian A, Thélu CÉ, Lesbats V, O’Shea K, Schaer M, Boileau P (2016) SECEC Research Grant 2008 II: use of platelet- and leucocyte-rich fibrin (L-PRF) does not affect late rotator cuff tendon healing: a prospective randomized controlled study. J Shoulder Elbow Surg 25(1):2–11CrossRefPubMed

36.

Everts PA, Devilee RJ, BrownMahoney C, van Erp A, Oosterbos CJ, Stellenboom M, Knape JT, van Zundert A (2008) Exogenous application of platelet-leukocyte gel during open subacromial decompression contributes to improved patient outcome. A prospective randomized double-blind study. Eur Surg Res 40(2):203–210CrossRefPubMed

37.

Mishra A, Pavelko T (2006) Treatment of chronic elbow tendinosis with buffered platelet-rich plasma. Am J Sports Med 34(11):1774–1778CrossRefPubMed

38.

Jo CH, Shin JS, Huh J (2014) Multimodal analgesia for arthroscopic rotator cuff repair: a randomized, placebo-controlled, double-blind trial. Eur J Orthop Surg Traumatol 24(3):315–322CrossRefPubMed

Titel: Platelet-rich plasma supplementation in arthroscopic repair of full-thickness rotator cuff tears: a randomized clinical trial
verfasst von: R. D’Ambrosi
F. Palumbo
A. Paronzini
V. Ragone
R. M. Facchini
Publikationsdatum: 01.12.2016
Verlag: Springer Milan
Erschienen in: MUSCULOSKELETAL SURGERY / Ausgabe Sonderheft 1/2016
Print ISSN: 2035-5106
Elektronische ISSN: 2035-5114
DOI: https://doi.org/10.1007/s12306-016-0415-2

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Abstract

Background

Methods

Results

Conclusions

Level of evidence

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