title: The effect of platelet-rich fibrin matrix on rotator cuff tendon healing: a prospective, randomized clinical study.
abstract: BACKGROUND
  There is a strong need for methods to improve the biological potential of rotator cuff tendon healing. Platelet-rich fibrin matrix (PRFM) allows delivery of autologous cytokines to healing tissue, and limited evidence suggests a positive effect of platelet-rich plasma on tendon biology.
  
  
  OBJECTIVE
  To evaluate the effect of platelet-rich fibrin matrix on rotator cuff tendon healing.
  
  
  METHODS
  Randomized controlled trial; Level of evidence, 2.
  
  
  METHODS
  Seventy-nine patients undergoing arthroscopic rotator cuff tendon repair were randomized intraoperatively to either receive PRFM at the tendon-bone interface (n = 40) or standard repair with no PRFM (n = 39). Standardized repair techniques were used for all patients. The postoperative rehabilitation protocol was the same in both groups. The primary outcome was tendon healing evaluated by ultrasound (intact vs defect at repair site) at 6 and 12 weeks. Power Doppler ultrasound was also used to evaluate vascularity in the peribursal, peritendinous, and musculotendinous and insertion site areas of the tendon and bone anchor site. Secondary outcomes included standardized shoulder outcome scales (American Shoulder and Elbow Surgeons [ASES] and L'Insalata) and strength measurements using a handheld dynamometer. Patients and the evaluator were blinded to treatment group. All patients were evaluated at minimum 1-year follow-up. A logistic regression model was used to predict outcome (healed vs defect) based on tear severity, repair type, treatment type (PRFM or control), and platelet count.
  
  
  RESULTS
  Overall, there were no differences in tendon-to-bone healing between the PRFM and control groups. Complete tendon-to-bone healing (intact repair) was found in 24 of 36 (67%) in the PRFM group and 25 of 31 (81%) in the control group (P = .20). There were no significant differences in healing by ultrasound between 6 and 12 weeks. There were gradual increases in ASES and L'Insalata scores over time in both groups, but there were no differences in scores between the groups. We also found no difference in vascularity in the peribursal, peritendinous, and musculotendinous areas of the tendon between groups. There were no differences in strength between groups. Platelet count had no effect on healing. Logistic regression analysis demonstrated that PRFM was a significant predictor (P = .037) for a tendon defect at 12 weeks, with an odds ratio of 5.8.
  
  
  CONCLUSIONS
  Platelet-rich fibrin matrix applied to the tendon-bone interface at the time of rotator cuff repair had no demonstrable effect on tendon healing, tendon vascularity, manual muscle strength, or clinical rating scales. In fact, the regression analysis suggests that PRFM may have a negative effect on healing. Further study is required to evaluate the role of PRFM in rotator cuff repair.
authors.affiliation: The Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. rodeos@hss.edu
authors.forename: Scott A
authors.initials: SA
authors.lastname: Rodeo
authors.forename: Demetris
authors.initials: D
authors.lastname: Delos
authors.forename: Riley J
authors.initials: RJ
authors.lastname: Williams
authors.forename: Ronald S
authors.initials: RS
authors.lastname: Adler
authors.forename: Andrew
authors.initials: A
authors.lastname: Pearle
authors.forename: Russell F
authors.initials: RF
authors.lastname: Warren
mesh_terms: D000368:Aged; D001182:Arthroscopy / Q000379:methods / Q000534:rehabilitation*; D005260:Female; D005337:Fibrin / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology; D019637:Orthopedic Procedures / Q000534:rehabilitation*; D053657:Platelet-Rich Plasma; D017006:Rotator Cuff / Q000000981:diagnostic imaging / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D012720:Severity of Illness Index; D019534:Shoulder Impingement Syndrome / Q000000981:diagnostic imaging / Q000534:rehabilitation* / Q000601:surgery; D013708:Tendon Injuries / Q000000981:diagnostic imaging / Q000534:rehabilitation* / Q000601:surgery; D016896:Treatment Outcome; D014463:Ultrasonography; D014945:Wound Healing
chemical_list: D005337:Fibrin