Platelet-Rich Product Supplementation in Rotator Cuff Repair Reduces Retear Rates and Improves Clinical Outcomes: A Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Author(s):  
James Ryan ◽  
Casey Imbergamo ◽  
Suleiman Sudah ◽  
Greg Kirchner ◽  
Patricia Greenberg ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Randomized Controlled Trials ◽  
Clinical Outcomes ◽  
Rotator Cuff Repair ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Cuff Repair

The Effect of Platelet-Rich Plasma Leukocyte Concentration on Arthroscopic Rotator Cuff Repair: A Network Meta-analysis of Randomized Controlled Trials

2020 ◽  
pp. 036354652097543
Author(s):  
Eoghan T. Hurley ◽  
Christopher A. Colasanti ◽  
Utkarsh Anil ◽  
Tyler A. Luthringer ◽  
Michael J. Alaia ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Randomized Controlled Trials ◽  
Platelet Rich Plasma ◽  
Meta Analysis ◽  
Tendon Healing ◽  
Controlled Trials ◽  
Analog Scale ◽  
Randomized Controlled ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Background: It is unclear whether leukocyte-poor (LP) or leukocyte-rich (LR) varieties of platelet-rich plasma (PRP) as an adjuvant to arthroscopic rotator cuff repair (ARCR) result in improved tendon healing rates. Purpose: To perform a network meta-analysis of the randomized controlled trials in the literature to ascertain whether there is evidence to support the use of LP- or LR-PRP as an adjunct to ARCR. Methods: The literature search was based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Randomized controlled trials comparing LP- or LR-PRP with a control alongside ARCR were included. Clinical outcomes, including retears and functional outcomes, were compared using a frequentist approach to network meta-analysis, with statistical analysis performed using R. The treatment options were ranked using the P-score. Results: There were 13 studies (868 patients) included, with 9 studies comparing LP-PRP with a control and 4 studies comparing LR-PRP with a control. LP-PRP was found to significantly reduce the rate of retear and/or incomplete tendon healing after fixation, even among medium-large tears; it also improved outcomes on the visual analog scale for pain, Constant score, and University of California Los Angeles score. LP-PRP had the highest P-score for all treatment groups. LR-PRP did not result in any significant improvements over the control group, except for visual analog scale score for pain. However, post hoc analysis revealed that LP-PRP did not lead to significant improvements over LR-PRP in any category. Conclusion: The current study demonstrates that LP-PRP reduces the rate of retear and/or incomplete tendon healing after ARCR and improves patient-reported outcomes as compared with a control. However, it is still unclear whether LP-PRP improves the tendon healing rate when compared with LR-PRP.

Arthroscopic single-row versus double-row repair rotator cuff tear: a meta-analysis of randomized controlled trials at 2-years minimum follow-up

2019 ◽  
Author(s):  
Pu Chen ◽  
Liuwei Huang ◽  
Xiaozhe Zhang ◽  
Jun Zhou ◽  
Anmin Ruan ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Randomized Controlled Trials ◽  
Clinical Outcomes ◽  
Constant Score ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Double Row ◽  
Single Row ◽  
Randomized Controlled

Abstract Objective: The purpose of this study was to perform a meta-analysis of all available randomized controlled trials at 2-years minimum follow-up, to compare the clinical outcomes and radiological re-tear rates between single-row (SR) and double-row (DR) fixation. Methods: PubMed, EMBASE, and Cochrane databases search were performed for meta-analysis. Randomized controlled trials at 2-years minimum follow-up which comparing clinical outcomes and radiological re-tear rates between single-row and double-row fixation for rotator cuff repair. Clinical outcomes included the American Shoulder and Elbow Surgeons score (ASES), University of California–Los Angeles score (UCLA), and Constant score; the radiological re-tear rate was assessed by Magnetic Resonance Imaging (MRI), Magnetic Resonance Angiography (MRA)or Ultrasonic (US). Two trained authors extracted data from all included articles, and if there are different opinions, the final decision would be made by the senior professor after reviewed the article.Results: Six Level Ⅰ articles and two Level Ⅱ articles were included. In clinical outcomes, ASES, Constant score and forward flexion range of motion (ROM) showed no statistically significant difference between DR fixation and SR fixation technique at 2-years follow-up (P=0.61, P=0.19, P=0.17). UCLA score and internal rotation ROM were significantly better in DR group (P=0.005, P=0.001). DR repair showed less overall re-tear and partial re-tear rate and more intact rotator cuff than SR repair in radiological outcomes after 2-years follow-up (P=0.0002, P=0.02, P=0.0003).Conclusion: The best current available evidence suggest that DR fixation technique have similar outcomes in ASES, Constant score and forward flexion ROM with SR fixation. However, DR group show higher UCLA score, greater internal rotation ROM and better radiological outcomes (include less overall re-tear and partial re-tear rate and more intact rotator cuff) than SR group after 2-years follow-up.Level of Evidence: Level Ⅱ, meta-analysis

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