Systematic Review of Platelet-Rich Plasma for Rotator Cuff Repair: Are We Adhering to the Minimum Information for Studies Evaluating Biologics in Orthopaedics?

Abstract

Background: The therapeutic efficacy of orthobiologic therapies for rotator cuff repair is difficult to evaluate owing to reporting inconsistences. In response, the Minimum Information for Studies Evaluating Biologics in Orthopaedics (MIBO) guidelines were developed to ensure standard reporting on orthobiologic therapies. Purpose: To systematically review clinical studies evaluating platelet-rich plasma (PRP) for full-thickness rotator cuff repair and adherence to MIBO guidelines. Study Design: Scoping review; Level of evidence, 4. Methods: A search was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using PubMed, EMBASE, and the Cochrane Library databases. Inclusion criteria were clinical studies reporting on rotator cuff tears (≥1 cm) surgically repaired with PRP. Patient demographics, biologic intervention, and adherence to the MIBO guidelines were systematically reviewed. Results: A total of 19 studies (1005 patients) were included in this review. Across all studies, 58.5% of the MIBO checklist items for PRP were reported. Out of 47 checklist items, 19 were reported in over 85% of studies, whereas 22 were reported in less than half of studies. Details of whole-blood processing and characteristics, as well as PRP processing and characteristics, were reported inconsistently, and no study provided adequate information to enable the precise replication of preparation protocols for PRP. Conclusion: This systematic review highlights the current reporting deficiencies within the scientific literature of important variables for evaluating PRP for full-thickness rotator cuff repair. There was widespread variability among published studies that evaluate PRP for this application and, more specifically, studies were limited by inconsistent universal reporting of whole-blood and PRP processing and postprocessing characteristics. To improve our understanding of biologic efficacy and to promote repeatability, stricter adherence to the MIBO guidelines is necessary. We propose that the checklist limitations be addressed and that modification of the MIBO guidelines be considered to improve the reporting of individual components within certain categories.

Collagen and platelet-rich plasma in partial-thickness rotator cuff injuries. Friends or only indifferent neighbours? Randomised controlled trial

“…Due to the risk of surgery, reduced strength of RC tendons, and a significant risk of injury recurrence, conservative options are the first choice, especially in older adults [11,12]. These conservative procedures comprise physical therapy and pharmacotherapy with steroid injections for anti-inflammatory effects, platelet-rich plasma (PRP), collagen injections, and autologous conditioned serum (ACS) for regenerative effects, as well as rehabilitation management [13][14][15].…”

Injectable orthobiologics in professional football (soccer) players: a systematic review

“…17 , 19 , 21 , 22 Nazaroff et al, 35 in a systematic review of level I and II studies on PRP among all medical specialties, revealed an alarming sub-registry of its composition in 36 of 97 studies (37%) in musculoskeletal specialties. Similarly, DeClercq et al, 39 in a scooping review comprising 19 studies on PRP for rotator cuff repair, revealed poor adherence to the MIBO for whole blood characteristics (57.9%), PRP characteristics (21%), the time between blood drawing up to delivery (89.5%), and activation (89.47%).…”

“…Therefore, the ideal composition, dose, and administration protocols are yet to be defined, despite its implementation in clinical practice keeps outpacing the available supporting evidence. [35][36][37][38][39] Only one study included in this systematic review analyzed whole blood and PRP composition, 21 and four the platelet recovery rate. 17 , 19 , 21 , 22 Nazaroff et al, 35 in a systematic review of level I and II studies on PRP among all medical specialties, revealed an alarming sub-registry of its composition in 36 of 97 studies (37%) in musculoskeletal specialties.…”

An Update on Orthobiologics: Cautious Optimism

“…Only approximately 58.5% of the variables represented in the MIBO criteria are reported by studies evaluating PRP in full-thickness rotator cuff tears. 31 Critical information including processing characteristics and activation was commonly omitted. Overall, without standardized reporting of information, the efficacy for PRP augmentation with rotator cuff repair remains equivocal.…”