Monday, October 10, 2011

Not looking Good for PRP and its true benefit

Does Platelet-Rich Plasma Accelerate Recovery After Rotator Cuff Repair? A Prospective Cohort Study

Background: Platelet-rich plasma (PRP) has been recently used to enhance and accelerate the healing of musculoskeletal injuries and diseases, but evidence is still lacking, especially on its effects after rotator cuff repair.

Hypothesis: Platelet-rich plasma accelerates recovery after arthroscopic rotator cuff repair in pain relief, functional outcome, overall satisfaction, and enhanced structural integrity of repaired tendon.
Study Design: Cohort study; Level of evidence, 2.

Methods: Forty-two patients with full-thickness rotator cuff tears were included. Patients were informed about the use of PRP before surgery and decided themselves whether to have PRP placed at the time of surgery. Nineteen patients underwent arthroscopic rotator cuff repair with PRP and 23 without. Platelet-rich plasma was prepared via plateletpheresis and applied in the form of a gel threaded to a suture and placed at the interface between tendon and bone. Outcomes were assessed preoperatively and at 3, 6, 12, and finally at a minimum of 16 months after surgery (at an average of 19.7 ± 1.9 months) with respect to pain, range of motion, strength, and overall satisfaction, and with respect to functional scores as determined using the following scoring systems: the American Shoulder and Elbow Surgeon (ASES) system, the Constant system, the University of California at Los Angeles (UCLA) system, the Disabilities of the Arm, Shoulder and Hand (DASH) system, the Simple Shoulder Test (SST) system, and the Shoulder Pain and Disability Index (SPADI) system. At a minimum of 9 months after surgery, repaired tendon structural integrities were assessed by magnetic resonance imaging.

Results: Platelet-rich plasma gel application to arthroscopic rotator cuff repairs did not accelerate recovery with respect to pain, range of motion, strength, functional scores, or overall satisfaction as compared with conventional repair at any time point. Whereas magnetic resonance imaging demonstrated a retear rate of 26.7% in the PRP group and 41.2% in the conventional group, there was no statistical significance between the groups (P = .388).

Conclusion: The results suggest that PRP application during arthroscopic rotator cuff repair did not clearly demonstrate accelerated recovery clinically or anatomically except for an improvement in internal rotation. Nevertheless, as the study may have been underpowered to detect clinically important differences in the structural integrity, additional investigations, including the optimization of PRP preparation and a larger randomized study powered for healing rate, are necessary to further determine the effect of PRP.



Dr_Alan_Bauman said...

What was the platelet concentration? Which process was used to create the PRP? How was it activated? Applied? Unless I'm missing something here, this study seems to leave out some VERY important details relating to peer-reviewed research. It's kind of like saying, "well, I watered my plant but it still died." How much water, how often? When investigators figure out how to describe the dose and preparation they are using, research and progress will be made in the use of PRP and orthopedics as well as hair loss and hair transplantation. Until then, not so much! --Dr. Alan Bauman

Dr. Rick Rosa said...

All great point my comments are more towards the trend of articles that was the 3rd one I came across. Over the past few months. I still feel there is value here but we need dig a little further.