Platelet Rich Plasma for high risk and recurrent rotator cuff tears
Authors: Lennard Funk & Brendan Fourie
References: Presented at the International Meeting on the use of Autologous Growth Factors in Orthopaedics and Sports Medicine: "State of the Art" - Krakow, Poland - 24 April 2009
It is well recognised that certain rotator cuff tears are at a higher risk of failure after repair [1.2,3]. The author reviewed and presented his results of arthroscopic rotator cuff repairs over a four year period in 2007. The failure rate on ultrasound scan was 8.5% [4]. Although this figure is lower than many other studies we did identify specific predictors of failure. The highest predictor of failure was poor quality rotator cuff tendon identified at the time of surgery, followed by tear size and age. In this group the failure rate of primary repair was 81%.
Our techniques and materials for rotator cuff repair have advanced substantially with extremely strong double row repairs using high strength anchors and suture materials. Therefore, the biological aspect of rotator cuff pathology needs to be addressed to improve outcomes.
Platelet rich plasma (PRP) offers an exciting option to accelerate and enhance healing of tendons. It is safe, simple and affordable. We have been using it as an orthobiologic for arthroscopic rotator cuff repairs in revision cases and those with poor quality rotator cuff tendons since May 2007 (3 years).
Between May 2007 and February 2009 the senior author (LF) performed eighteen arthroscopic rotator cuff repairs with PRP as an adjuvant for these high risk and recurrent rotator cuff tears only.
The mean age of the patients was 57.2 (range 49-68). All patients were physically active and previously of high functional demand. Eight of these cases were revision procedures. Thirteen patients had large (3-5cm) cuff tears and three had massive tears (>5cm). Cuff tissue quality was intermediate and delaminated in five and poor and thinned in eleven cases.
A single row repair was performed in six cases, whilst all the others had a double-row suture-bridge repair using the technique previously published by LF [5]. Following repair, PRP (GPS 2, Biomet Biologics Ltd.) was applied over the repair site and injected into the tendon.
Eleven patients had a follow up of more than six months and were included in the results below.
The outcome data is summarized in the table
| Outcome | Pre-op | Post-op |
| Abduction | 64.3 | 142.5 |
| Flexion | 72.9 | 142.5 |
| Constant Score | 30.3 | 73.5 |
| Oxford Score | 33 | 16.7 |
| Pain Score (1-10) | 6.6 | 2.3 |
| Subjective Improvement | 73.3% | |
| Patient Satisfaction | 86.7% |
Seven patients had post-operative ultrasound scans. Of these, six repairs were intact and one had failed with a failure rate of 14.3% (compared with a previous failure rate of 81% in the same group of patients prior to PRP). This failed case was a second revision procedure in a young patient who was an avid smoker with a massive, poor and thinned cuff tear.
In conclusion, these early results seem to suggest that PRP may have a role in improving the outcomes of rotator cuff repairs in situations of poor tendon quality and for revision rotator cuff surgery. We will continue to analyze our results prospectively and provide longer term outcomes and biopsy data in future studies.
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