Summary

The use of PRP with arthroscopic rotator cuff repair may contribute to enhanced tendon healing, reduced pain, and better functional recovery, while also potentially lowering the risk of re-tears

Abstract

Introduction

Arthroscopic repair is currently the mainstay for the management of rotator cuff tears and includes various methods ranging from single row repairs to augmentation with other tissue engineering techniques. Arthroscopic repair has become the standard surgical approach, but concerns about re-tears and incomplete healing remain. To enhance healing, the use of bio-augmentation techniques, such as Platelet Rich Plasma (PRP), has gained attention.
Objectives:
The primary objective of this study was to evaluate the clinical and radiological outcomes of patients undergoing arthroscopic repair of rotator cuff tears with the adjunctive use of Platelet Rich Plasma (PRP). The study aimed to determine the efficacy of PRP in improving postoperative healing and reducing the incidence of re-tears.

Methods

This prospective interventional study included 40 patients with a mean age of 56.55 years. All patients underwent arthroscopic repair, with PRP administered intraoperatively at the repair site. Clinical outcomes were assessed using the Visual Analog Scale (VAS) for pain, the Constant-Murley Score (CMS), the Disabilities of Arm, Shoulder, and Hand (DASH) and the University of California, Los Angeles (UCLA) score. Radiological outcomes were evaluated through Magnetic Resonance Imaging (MRI) to assess tendon healing and integrity at 6 months follow-up.

Results

The results demonstrated a significant improvement in clinical outcomes, with reduced pain scores (VAS) and improved functional scores in patients who received PRP. The VAS score improved from a pre-operative value of 5.65 ± 0.81 to 1.40 ± 0.50 at 1-year post-operatively. The CMS improved from 17.60 ± 2.83 pre-operatively to 59.00 ± 6.48, UCLA score improved from 7.25 ± 1.44 pre-operatively to 26.30 ± 3.33 and DASH score improved from 77.175 ± 5.27 preoperatively to 21.23 ± 2.46 at 1-year post-operatively. MRI evaluations showed a good tendon healing and lower incidence of re-tears (Sugaya classification) in the study with 75% (30 out of 40) categorized as Sugaya types 1 and 2, 15% of patients (6 out of 40) categorized as Sugaya type 3 and 10% of patients (4 out of 40) fell into Sugaya type 5. There was evidence of re-tear in 10% of patients in the 6-month post-operative MRI (Retear in conventional group in literature is 20%- Joe et al). The addition of PRP also appeared to enhance the quality of tendon healing, as evidenced by the more robust tendon-to-bone interface observed in follow-up imaging.

Conclusion

The use of PRP with arthroscopic rotator cuff repair may contribute to enhanced tendon healing, reduced pain, and better functional recovery, while also potentially lowering the risk of re-tears.