title: Does Pure Platelet-Rich Plasma Affect Postoperative Clinical Outcomes After Arthroscopic Rotator Cuff Repair? A Randomized Controlled Trial.
abstract: The exact role of platelet-rich plasma (PRP) in rotator cuff tendon reconstruction remains unclear.
  
  
  
  This study investigated whether an intraoperative pure PRP injection, compared with a local anesthetic injection, improves patient-reported outcomes at 3 and 6 months after arthroscopic rotator cuff repair. The hypothesis was that pure PRP improves patient-reported outcomes (Oxford Shoulder Score [OSS]) at 3 and 6 months after surgery and has the same pain-reducing effect compared with a postoperative subacromial local anesthetic (ropivacaine) injection.
  
  
  
  Randomized controlled trial; Level of evidence, 1.
  
  
  
  Between January 2011 and November 2012, a total of 120 patients who underwent arthroscopic double-row repair of a supraspinatus tendon rupture were randomized to receive either pure PRP by an injection at the footprint (PRP group; n = 60) or ropivacaine injected in the subacromial region (control group; n = 60). Seventy-eight percent of patients had other concomitant tears. All patients, surgeons, and follow-up investigators were blinded. Clinical parameters and various outcome scores (Constant-Murley shoulder score; OSS; patient American Shoulder and Elbow Surgeons score; quick Disabilities of the Arm, Shoulder and Hand score; EuroQol 5 dimensions) were documented preoperatively and at 3, 6, and 24 months postoperatively. The repair integrity was assessed by magnetic resonance imaging or ultrasound at 24 months. Furthermore, a pain diary was completed within the first 10 postoperative days, and adverse events were recorded. Group outcome differences were analyzed using t tests, Fisher exact tests, and mixed models.
  
  
  
  The final follow-up rate was 91%. An associated tear of the subscapularis tendon was diagnosed in 23% of PRP-treated patients and 36% of control patients. Three months after surgery, the mean (±SD) OSS was 32.9 ± 8.6 in PRP-treated patients and 30.7 ± 10.0 in control patients (P = .221). No significant differences were noted for other outcome parameters as well as at 6 and 24 months postoperatively. Smoking was a significant effect modifier. Pain for both groups decreased from postoperative day 1 to 10 without any significant group difference (P = .864). Six (12.2%) and 11 (20.8%) patients were diagnosed with a recurrent supraspinatus tendon defect in the PRP and control groups, respectively (P = .295). Twenty-two (40.7%) and 18 (30.5%) PRP-treated and control patients, respectively, experienced a local adverse event within 24 months (P = .325).
  
  
  
  Patients treated with pure PRP showed no significantly improved function at 3, 6, and 24 months after arthroscopic repair compared with control patients receiving ropivacaine; however, a similar pain reduction was documented in both groups. The negative influence of smoking on the effect of pure PRP requires further investigation.
  
  
  
  NCT01266226 (ClinicalTrials.gov).
authors.affiliation: Upper Extremities, Schulthess Clinic, Zurich, Switzerland matthias.flury@kws.ch.
authors.forename: Matthias
authors.initials: M
authors.lastname: Flury
authors.affiliation: Research and Development Department, Schulthess Clinic, Zurich, Switzerland.
authors.forename: Dominik
authors.initials: D
authors.lastname: Rickenbacher
authors.affiliation: Upper Extremities, Schulthess Clinic, Zurich, Switzerland.
authors.forename: Hans-Kaspar
authors.initials: HK
authors.lastname: Schwyzer
authors.affiliation: Upper Extremities, Schulthess Clinic, Zurich, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Jung
authors.affiliation: Upper Extremities, Schulthess Clinic, Zurich, Switzerland.
authors.forename: Marco M
authors.initials: MM
authors.lastname: Schneider
authors.affiliation: Upper Extremities, Schulthess Clinic, Zurich, Switzerland.
authors.forename: Katharina
authors.initials: K
authors.lastname: Stahnke
authors.affiliation: Research and Development Department, Schulthess Clinic, Zurich, Switzerland.
authors.forename: Jörg
authors.initials: J
authors.lastname: Goldhahn
authors.affiliation: Upper Extremities, Schulthess Clinic, Zurich, Switzerland Research and Development Department, Schulthess Clinic, Zurich, Switzerland.
authors.forename: Laurent
authors.initials: L
authors.lastname: Audigé
mesh_terms: D000328:Adult; D000368:Aged; D000577:Amides / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage; D001182:Arthroscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D053657:Platelet-Rich Plasma; D000077212:Ropivacaine; D000070636:Rotator Cuff Injuries / Q000150:complications / Q000601:surgery*; D012421:Rupture / Q000601:surgery; D012907:Smoking / Q000009:adverse effects; D013708:Tendon Injuries / Q000150:complications; D016896:Treatment Outcome; D014945:Wound Healing
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine
keywords: pain; patient-reported outcomes; platelet-rich plasma; rotator cuff repair