Efficacy of platelet-rich plasma in the treatment of rotator cuff tears

Study Type: ACE Review
OE Level of Evidence: N/A
Journal Level of Evidence: N/A
Synopsis
Ten ACE Reports (all randomized controlled trials) were identified from the OrthoEvidence database assessing the efficacy of platelet-rich plasma (PRP) versus control in the treatment of rotator cuff tears. Result are presented for Constant scores, University of California (UCLA) scores, American Shoulder and Elbow Surgeons (ASES) scores, Simple Shoulder Test (SST) scores, Shoulder Pain and Disability Index (SPADI), Sugaya classification, and the incidence of retear. Qualitative descriptions were Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Sponsor: Conflicts:
Industry funded Biomet Biologics Consultant
Funding: Sponsor: Conflicts:
Non-funded None disclosed
Funding: Sponsor: Conflicts:
Industry funded Musculoskeletal Transplant Foundation, Cayenne Medical, Smith & Nephew, Biomet, ConMed, and Phillips Medical Systems Royalties
Funding: Sponsor: Conflicts:
Non-Industry funded Txagorritxa Hospital, Basque Country University None disclosed
Funding: Sponsor: Conflicts:
Non-Industry funded Sutter Institute for Medical Research None disclosed
Funding: Sponsor: Conflicts:
Non-Industry funded National Research Foundation of Korea None disclosed
Funding: Sponsor: Conflicts:
Not Reported None disclosed
Funding: Sponsor: Conflicts:
Non-Industry funded Basic Science Research Program and the Bio & Medical Technology Development Program of the National Research Foundation (NRF) funded by the Korean Government None disclosed
Funding: Sponsor: Conflicts:
Not Reported None disclosed
Funding: Sponsor: Conflicts:
Non-Industry funded Spanish Society of Orthopedics & Traumatology (SECOT). None disclosed
Background
Rotator cuff tears are one of those most common causes of shoulder pain and disability among adults. While conservative methods can be used in management in most scenarios, full-thickness tears frequently require surgical intervention in order to regain normal function, and arthroscopic repair is usually performed when patients do not respond to conservative treatment. Although surgical repair is often met with reduced pain and functional, it is not uncommon to find a substantial failure rate in those who undergo surgery. Thus, researchers have been investigating potential adjunct therapies and methods in order to improve outcome following rotator cuff tears, which has brought recent popularity to the application of platelet-rich plasma in rotator cuff disease management. The efficacy of platelet-rich plasma and its associated derivatives is predicated on the delivery of a high concentration of growth factors to the affected site, with subsequent improved healing. Despite advocacy by some authors in favour of platelet-rich plasma, a large proportion of research has also suggested no beneficial effect of conditioned plasma in rotator cuff tear treatment. Accordingly, this review was performed in to investigate the combined efficacy of platelet-rich plasma from the available literature.
What was the principal research question?
Were outcomes following treatment for rotator cuff pathology improved upon with the application of platelet-rich plasma (or related product) compared to control treatment?
Report Characteristics: 10 reports from the OrthoEvidence database were identified assessing the use of platelet-rich plasma (or platelet-rich plasma derivative) in the treatment of rotator cuff tears. All 10 reports included were summaries of randomized controlled trials. The publication dates of the included studies occurred in the two-year time period, from February 2011 to November 2013. A total of 578 patients were included throughout the 10 trials.
Report Selection: The following terms were used to search the OrthoEvidence database for relevant articles: "platelet-rich plasma", "plasma rich in growth factors", "platelet-rich fibrin matrix", and "conditioned plasma". The search identified 36 articles for possible inclusion. Screening the identified articles on the basis of the inclusion criteria resulted in the exclusion of 26 reports, and left 10 reports for inclusion. Inclusion criteria were: studies that (1) assessed the use of platelet-rich plasma (or similarly derived product) in (2) the treatment (conservative or operative) of rotator cuff tears/tendinopathy and (3) reported function or pain outcomes using a validated instrument, or assessed the postoperative integrity of the rotator cuff.
Outcomes: The outcome measures used in the included trials were: the Constant score, the University of California, L.A. (UCLA) score, the American Shoulder and Elbow Surgeons (ASES) score, and Simple Shoulder Test (SST) for postoperative functional outcome; the Sugaya classification and additional magnetic resonance imaging (MRI) findings for postoperative rotator cuff integrity and incidence of retear; a visual analog scale (VAS) and the Shoulder Pain and Disability Index (VAS) for pain; and range of motion (ROM) assessments for shoulder function.
Heterogeneity: Heterogeneity was assessed using the I-squared statistic for poolable outcomes. Since heterogeneity was assumed to be high, pooling was conducted via a random effects model.
Report Details and Scores
CONTENT IS LOCKED
Pooling and Statistical Analysis
Main Findings
Forest Plot: Constant Score
Forest Plot: UCLA Score at 12 Months
Forest Plot: ASES Scores at 12 Months
Forest Plot: Simple Shoulder Test
Forest Plot: SPADI Scores at 3 and 6 months
Forest Plot: Incidence of retear
What should I remember most?
Implications for patient treatment and future research:
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.
May 12, 2013
I appreciate this study.
Dr. Ignacio Dallo
August 24, 2013
Argentina
I think we need histological studies and homogeneus studies groups
May 28, 2014
I agree with Dr. Dallo