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The clinical efficacy of leukocyte-poor platelet-rich plasma in arthroscopic rotator cuff repair: a meta-analysis of randomized controlled trials.

Di Zhao,Yanhong Han,Jian-ke Pan,Wei-yi Yang,Ling-feng Zeng,Gui-hong Liang,Jun Liu

Published 2020 in Journal of shoulder and elbow surgery

ABSTRACT

BACKGROUND The efficacy of platelet-rich plasma (PRP) in the arthroscopic treatment of rotator cuff injury has been reported in the literature. However, conclusions have been inconsistent and more often related to differences in the types of PRP used. Therefore, to minimize these differences, we performed a meta-analysis of only studies investigating leukocyte-poor PRP to evaluate whether PRP promotes and improves the effects of arthroscopic rotator cuff repair. METHODS A comprehensive search of the PubMed, Embase and Cochrane Library databases was conducted to evaluate the efficacy of leukocyte-poor PRP in arthroscopic rotator cuff repair. The available data were extracted, and the methodological quality of the included studies was evaluated by the Cochrane risk of bias assessment tool. RESULTS In total, 10 randomized controlled trials involving 742 patients were included. The results of the meta-analysis showed that treatment with leukocyte-poor PRP performed better in relieving postoperative pain than the control in the short-term [MD = -0.57, 95% CI (-0.79, -0.35), P < 0.0001] and long-term [MD = -0.18, 95% CI (-0.34, -0.03), P = 0.02]) follow-up. However, the changes in the mean VAS difference were below the MCID. Regarding the Constant shoulder [MD = 3.35, 95% CI (1.68, 5.02), P < 0.0001] and UCLA [MD = 1.73, 95% CI (0.94, 2.52), P < 0.0001] scores, there was a statistically significant difference in favor of leukocyte-poor PRP over the control. However, the changes in the mean difference of both the Constant and UCLA scores were below the MCID. Moreover, during the medium- and long-term follow-up, the retear rate in the leukocyte-poor PRP group was lower than that in the control group regardless of the rotator cuff tear size [small and medium (< 3 cm) ([RR = 0.64, 95% CI (0.43, 0.97), P = 0.03]) vs medium and large (> 3 cm) ([RR = 0.51, 95% CI (0.34, 0.77), P = 0.001])] and surgical repair methods (single-row repair ([RR = 0.61, 95% CI (0.43, 0.87), P = 0.007]) vs double-row suture bridge repair ([RR = 0.57, 95% CI (0.38, 0.84), P = 0.005])). CONCLUSION According to the current study, leukocyte-poor PRP can significantly reduce the postoperative retear rate in the medium and long term regardless of the tear size and methods used for rotator cuff repair. However, the use of leukocyte-poor PRP in terms of postoperative pain and patient reported outcomes failed to show clinically meaningful effects. LEVEL OF EVIDENCE Level II; Systematic Review/Meta-Analysis.

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