title: Platelet-Rich Plasma Reduces Retear Rates After Arthroscopic Repair of Small- and Medium-Sized Rotator Cuff Tears but Is Not Cost-Effective.
abstract: BACKGROUND
  It has been suggested that platelet-rich plasma (PRP) improves healing after arthroscopic rotator cuff repair. The current literature provides ample but inconsistent data on this topic.
  
  
  OBJECTIVE
  To systematically review the current in vivo evidence for the use of platelet concentrates (PRP) in the arthroscopic treatment of rotator cuff tears to assess effectiveness, safety, and cost-effectiveness.
  
  
  METHODS
  Meta-analysis and cost-effectiveness analysis.
  
  
  METHODS
  Published evidence from controlled, human trials of rotator cuff repair augmented with platelet concentrates was systematically gathered, and data on retear rates were extracted. Mathematical and clinical heterogeneity was evaluated, and fixed-effect meta-analysis was performed to calculate the risk ratio (RR) of retears and the number needed to treat (NNT). Subgroup analyses were made for small/medium tears (n = 404) and large/massive tears (n = 374). Cost-effectiveness was assessed using data from this meta-analysis and using cost data from the literature, including extensive sensitivity analyses, to calculate the incremental cost-effectiveness ratio (ICER).
  
  
  RESULTS
  Thirteen studies published between 2010 and 2014 were identified for analysis. The RR for retear for all patients was 0.87 (95% CI, 0.67-1.12; P = .286). For small- and medium-sized tears (<3 cm), the RR for retear was 0.60 (95% CI, 0.37-0.97), consistent with a significant difference in favor of PRP use (P = .038). This translated into an NNT of 14 (95% CI, 7-125). However, at an ICER of US$127,893 per quality-adjusted life year gained, assuming a 5% revision rate, the use of PRP was not cost-effective for small- and medium-sized tears.
  
  
  CONCLUSIONS
  In large tears, even with double-row repair, the beneficial effects of PRP alone are insufficient to compensate the progressed tissue damage. The study data suggest that PRP may promote healing of small- and medium-sized tears to reduce retear rates. However, despite the substantial biological effect, at current cost, the use of PRP is not cost-effective in arthroscopic repair of small- and medium-sized tears.
authors.affiliation: Division of Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA Harvard Center for Population and Development Studies, Harvard School of Public Health, Boston, Massachusetts, USA Department of Orthopaedic Surgery, University Hospital Basel, Basel, Switzerland patrick.vavken@childrens.harvard.edu.
authors.forename: Patrick
authors.initials: P
authors.lastname: Vavken
authors.affiliation: Department of Orthopaedic Surgery, Medical University Graz, Graz, Austria.
authors.forename: Patrick
authors.initials: P
authors.lastname: Sadoghi
authors.affiliation: Harvard Business School, Cambridge, Massachusetts, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Palmer
authors.affiliation: Department of Orthopaedic Surgery, University Hospital Basel, Basel, Switzerland ALTIUS Swiss Sportmed Center, Basel, Switzerland.
authors.forename: Claudio
authors.initials: C
authors.lastname: Rosso
authors.affiliation: Department of Orthopaedic Surgery, University Hospital Basel, Basel, Switzerland.
authors.forename: Andreas M
authors.initials: AM
authors.lastname: Mueller
authors.affiliation: Department of Orthopaedic Surgery, University Hospital Basel, Basel, Switzerland.
authors.forename: Gregor
authors.initials: G
authors.lastname: Szoelloesy
authors.affiliation: Department of Orthopaedic Surgery, University Hospital Basel, Basel, Switzerland.
authors.forename: Victor
authors.initials: V
authors.lastname: Valderrabano
mesh_terms: D001182:Arthroscopy; D003362:Cost-Benefit Analysis; D006801:Humans; D053657:Platelet-Rich Plasma; D019057:Quality-Adjusted Life Years; D012008:Recurrence; D012086:Reoperation; D017006:Rotator Cuff / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D016896:Treatment Outcome; D014945:Wound Healing
keywords: PRP; cost-effectiveness; evidence-based medicine; platelet; rotator cuff