Summary

Clinical and Functional Outcome of Rotator cuff Repairs treated with Platelet rich plasma gel augmentation and PRP booster injection, a randomised control study.

Abstract

Purpose

Rotator cuff surgery is a very commonly done procedure, but there is a high incidence of retear following surgical repair making this procedure challenging. Among the various available Orthobiologics, PRP is readily available and is being widely used. PRP in rotator cuff repair has shown mixed results because of lack of standardisation and a varied application protocol from study to study. The principal factors limiting our understanding of PRP and its clinical efficacy is heterogeneity. This study evaluates the functional outcome and pain reduction in patients who underwent rotator cuff repair with PRP gel augmentation during the repair followed by booster injections versus conventional rotator cuff repair without PRP augmentation.

Methodology

A randomized controlled study was conducted in which 36 patients diagnosed with rotator cuff tear were included as per the inclusion criteria. The patients were randomized into 2 groups, one group received no PRP, the 2nd group received PRP gel during surgery followed by PRP booster injections at 12th and 28th day follow up. The PRP gel was prepared by first using double-spin centrifugation, 9 mL of the extracted PRP was then mixed with 0.9 mL of 10% calcium gluconate loaded in a 5-mL syringe and this was used to produce a PRP gel. Intraoperatively after arthroscopic/mini-open rotator cuff repair, PRP gel was applied over the repaired cuff near the bone tendon interface. Functional outcome was assessed using ASES score and Constant and Murley score preoperatively and at 3, 6 month follow-up. Pain was assessed using VAS scale preoperatively and at postoperative days 12, 28, and 3 months.

Results

There were 18 patients each in both the non PRP and the PRP group. The time of surgery since injury was 4.7 months in the non PRP and 6.5 months in the PRP group. Most of the patients were either Snyder 3 or 4. The Goutallier staging was also similar in both groups. Both groups had similar number of Diabetic and non-Diabetics. Pre op Constant Murley, ASES and VAS scores were similar in both groups no statistical difference, The 4 weeks VAS score was better in the PRP group 1.64 versus the non PRP group (2.92) and this was statistically significant (p value=0.042) The 6 week VAS score was also better in the PRP group, but at 3 months and 6 months the VAS score was similar in both groups. The 3 month ASES score was 73 in the non PRP group vs 76.70 (p value=0.472)and this was not significant. The 6 month mean Constant and Murley(78.63 vs 67.67, p value=0.118) and ASES score(87.88 vs 87.33 p value=0.927)were similar in both the non PRP group and the PRP group.

Conclusion

Augmentation of PRP in rotator cuff repair showed decreased pain score at 4 weeks and 6 weeks compared to the non PRP group. Functional outcome was similar in both groups. So patients treated with PRP had better early pain score, but the functional outcome was similar in both groups.