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Platelet-rich plasma does not improve clinical results in patients with rotator cuff disorders but reduces the retear rate. A systematic review and meta-analysis

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To assess whether the use of Platelet-rich plasma (PRP) produces a clinical benefit in patients with rotator cuff disorders, treated either conservatively or surgically.

Methods

A systematic review was performed according to PRISMA guidelines on three databases (PubMed, Cochrane Library, Web of Science) to identify randomised controlled trials (RCTs) on the use of PRP in patients with rotator cuff disorders, treated either conservatively or surgically. A meta-analysis was performed on articles reporting results for Constant, UCLA, VAS, SST scores and retear rate. The RoB 2.0 and the modified Coleman Methodology Score were used to assess methodological quality.

Results

A total of 36 RCTs (20 surgical, 16 conservative) were included, for a total of 2,443 patients. Conservative treatment showed high heterogeneity and no clear consensus in favour of PRP. The meta-analysis of the studies with surgical treatment showed no benefit in using PRP in any of the clinical outcomes, either at the short or medium/long-term follow-up. However, the retear rate was lower with PRP augmentation (p < 0.001). The overall quality of the studies was moderate to high, with the surgical studies presenting a lower risk of bias than the conservative studies.

Conclusion

The use of PRP as augmentation in rotator cuff surgical repair significantly reduces the retear rate. However, no benefits were documented in terms of clinical outcomes. PRP application through injection in patients treated conservatively also failed to present any clear advantage. While there are many studies in the literature with several RCTs of moderate to high quality, the high heterogeneity of products and studies remains a significant limitation to fully understanding PRP potential in this field.

Level of evidence

Level I.

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Authors and Affiliations

  1. Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland

    Pietro Feltri, Giorgia Carlotta Gonalba, Christian Candrian & Giuseppe Filardo

  2. Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy

    Angelo Boffa

  3. Faculty of Biomedical Sciences, Università della Svizzera Italiana, Via Buffi 13, 6900, Lugano, Switzerland

    Christian Candrian & Giuseppe Filardo

  4. Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy

    Alessandra Menon & Pietro Simone Randelli

  5. Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, U.O.C. 1°, 20122, Milan, Italy

    Alessandra Menon & Pietro Simone Randelli

  6. Scuola di Specializzazione in Statistica Sanitaria e Biometria, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Via Della Commenda 19, 20122, Milan, Italy

    Alessandra Menon

  7. Research Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy

    Pietro Simone Randelli

  8. Applied and Translational Research (ATR) Center, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40137, Bologna, Italy

    Giuseppe Filardo

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  1. Pietro Feltri
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Feltri, P., Gonalba, G.C., Boffa, A. et al. Platelet-rich plasma does not improve clinical results in patients with rotator cuff disorders but reduces the retear rate. A systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 31, 1940–1952 (2023). https://doi.org/10.1007/s00167-022-07223-9

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