Efficacy of Platelet-Rich Plasma in Arthroscopic Rotator Cuff Repair a Systematic Review of Randomized Controlled Trials

Abstract

Introduction: Rotator cuff tears significantly impact shoulder function and quality of life. While arthroscopic repair is the gold standard treatment, retear rates remain considerable. Platelet-Rich Plasma (PRP) has emerged as a potential biological augmentation to enhance healing outcomes. This systematic review evaluated the efficacy of PRP in rotator cuff repair. Methods: We conducted a systematic review following PRISMA guidelines. Electronic databases were searched from inception through December 2024. Randomized controlled trials comparing PRP augmentation with control groups in rotator cuff repair were included. Two independent reviewers assessed study eligibility and risk of bias using the Cochrane RoB-2 tool. Primary outcomes included tendon healing, functional scores, and retear rates. Results: Ten randomized controlled trials (734 patients) were included. Seven studies reported tendon healing outcomes, with some showing significant improvements in cross-sectional area preservation in the PRP group. Retear rates varied considerably, with four studies reporting significantly lower rates in the PRP group (ranging from 3% vs. 20% to 20% vs. 55.6%). Nine studies found no significant differences in functional scores between groups. However, six studies reported significantly lower pain scores in the PRP group during the immediate postoperative period. Five studies demonstrated low risk of bias across all domains, while five showed some concerns primarily in the randomization process. Conclusions: PRP demonstrates consistent effectiveness in reducing post-operative pain (60% of included trials, 6 of 10, reported significantly lower postoperative pain scores) and shows a good promise for reducing retear rates in selected cases, despite that its impact on functional outcomes appears limited. The variation in outcomes suggests that PRP's effectiveness may be patient centered rather than generally applied.

Keywords: Platelet-Rich Plasma; Arthroscopic Rotator Cuff Repair; Rotator Cuff; Orthopedic Surgery; Pain Medicine