Does Pure Platelet-Rich Plasma Affect Postoperative Clinical Outcomes After Arthroscopic Rotator Cuff Repair?

Flury, Manuel; Rickenbacher, Dominik; Schwyzer, Hans‐Kaspar; Jung, Christian; Schneider, M. M.; Stahnke, Katharina; Goldhahn, Jörg; Audigé, Laurent

doi:10.1177/0363546516645518

Cited by 103 publications

(77 citation statements)

References 55 publications

(60 reference statements)

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“…However, a recent thorough meta-analysis of randomized controlled trials and a well-controlled study concluded that PRP improves rotator-cuff healing rates and functional outcomes and reduces pain levels. 34 , 35 Several recent studies have also found that combining PRP with surgical tendon repairs significantly improves tendon healing while reducing retear rates, which should also contribute to pain reduction. 36 – 38 A second limitation is that when pain relief was observed, it was not long-lasting, generally lasting only 6 months, 21 , 29 , 39 – 41 although complete pain relief >12 months has been reported.…”

Section: Introductionmentioning

confidence: 99%

Differing efficacies of autologous platelet-rich plasma in reducing pain following rotator-cuff injury in a single patient

Kuffler

2018

JPR

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Rotator-cuff tears (RCTs) are typically associated with chronic pain. The most common treatment for reducing pain is the injection of cortisone into the injury site. An alternative and increasingly used technique is the injection of autologous platelet-rich plasma (PRP). A limitation of cortisone is its pain relief is short-lived, while PRP has the limitation of providing pain relief to only about 50% of patients, making its efficacy questioned, although when it is effective, its efficacy is longer than cortisone. Little is known about what accounts for these limitations. This paper presents results from a patient with RCTs causing excruciating pain who received an injection of PRP into that shoulder resulting in complete pain elimination that was ongoing at 2 years and 2 months. When 7-month severe posttrauma pain associated with the RCT developed in the contralateral shoulder, PRP prepared the same way and injected by the same person who performed the first injection provided no pain relief. However, a subsequent single cortisone injection resulted in complete pain elimination, which was ongoing at >15 months. These observations indicate that PRP can have inconsistent effects in reducing pain, not only between patients but also within the same patient. Further, although the pain relief induced by cortisone is normally not long-lasting, when given following a PRP injection, it can induce complete pain relief lasting >15 months. This paper discusses possible reasons for the variability in PRP efficacy on pain relief and addresses the possibility that when administered together, PRP and cortisone may act in a complementary manner, leading to significantly greater and longer-lasting pain relief.

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Section: Introductionmentioning

confidence: 99%

Differing efficacies of autologous platelet-rich plasma in reducing pain following rotator-cuff injury in a single patient

Kuffler

2018

JPR

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“…Most authors reported on no positive effects of PRPs on the functional clinical outcome after tendon repair [ 61 , 62 , 63 , 64 ]. However, a positive effect on pain reduction was observed [ 21 , 65 ]. Therefore, also the expression of the pain associated factors COX1, COX2, and HGF were analyzed.…”

Section: Discussionmentioning

confidence: 99%

Comparative Analysis of Different Platelet Lysates and Platelet Rich Preparations to Stimulate Tendon Cell Biology: An In Vitro Study

Klatte‐Schulz

Schmidt

Uckert

et al. 2018

IJMS

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Abstract:The poor healing potential of tendons is still a clinical problem, and the use of Platelet Rich Plasma (PRP) was hypothesized to stimulate healing. As the efficacy of PRPs remains unproven, platelet lysate (PL) could be an alternative with its main advantages of storage and characterization before use. Five different blood products were prepared from 16 male donors: human serum, two PRPs (Arthrex, (PRP-ACP); RegenLab (PRP-BCT)), platelet concentrate (apheresis, PC), and PL (freezing-thawing destruction of PC). Additionally, ten commercial allogenic PLs (AlloPL) from pooled donors were tested. The highest concentration of most growth factors was found in AlloPL, whereas the release of growth factors lasted longer in the other products. PRP-ACP, PRP-BCT, and PC significantly increased cell viability of human tenocyte-like cells, whereas PC and AlloPL increased Col1A1 expression and PRP-BCT increased Col3A1 expression. MMP-1, IL-1β, and HGF expression was significantly increased and Scleraxis expression decreased by most blood products. COX1 expression significantly decreased by PC and AlloPL. No clear positive effects on tendon cell biology could be shown, which might partially explain the weak outcome results in clinical practice. Pooled PL seemed to have the most beneficial effects and might be the future in using blood products for tendon tissue regeneration.

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“…These patients were compared with a historical group of 20 patients who underwent suture-bridging doublerow repair with liquid PRP but without any xenograft patch augmentation. 2 The data from this interesting study provide insight into 4 areas: the retear (failure) rate, adverse events, the suture-bridging technique, and the use of PRP.…”

Section: See Related Article On Page 24mentioning

confidence: 94%

Editorial Commentary: Don't Pig Out When Selecting a Shoulder, Rotator Cuff Augmentation Graft! Xenografts Are Not the Way to Go

Barber¹

2018

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Porcine xenograft dermal onlay augmentation of rotator cuff repair does not provide improved cuff integrity or provide better clinical outcomes. The retear rate was actually higher in repairs augmented with a porcine xenograft than the control group. Adverse events occurred in 60% of the xenograft patients compared with 40% of the controls. The use of liquid platelet-rich plasma had no discernible impact. A total of 85% of the observed failures with the suture-bridging double-row repair were at the medial cuff (Cho type 2).

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Does Pure Platelet-Rich Plasma Affect Postoperative Clinical Outcomes After Arthroscopic Rotator Cuff Repair?

Abstract: NCT01266226 (ClinicalTrials.gov).

Cited by 103 publications

References 55 publications

Differing efficacies of autologous platelet-rich plasma in reducing pain following rotator-cuff injury in a single patient

Differing efficacies of autologous platelet-rich plasma in reducing pain following rotator-cuff injury in a single patient

Comparative Analysis of Different Platelet Lysates and Platelet Rich Preparations to Stimulate Tendon Cell Biology: An In Vitro Study

Editorial Commentary: Don't Pig Out When Selecting a Shoulder, Rotator Cuff Augmentation Graft! Xenografts Are Not the Way to Go

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