Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
Am J Sports Med. 2011 Oct;39(10):2082-90. doi: 10.1177/0363546511413454. Epub 2011 Jul 7.
Platelet-rich plasma (PRP) has been recently used to enhance and accelerate the healing of musculoskeletal injuries and diseases, but evidence is still lacking, especially on its effects after rotator cuff repair.
Platelet-rich plasma accelerates recovery after arthroscopic rotator cuff repair in pain relief, functional outcome, overall satisfaction, and enhanced structural integrity of repaired tendon.
Cohort study; Level of evidence, 2.
Forty-two patients with full-thickness rotator cuff tears were included. Patients were informed about the use of PRP before surgery and decided themselves whether to have PRP placed at the time of surgery. Nineteen patients underwent arthroscopic rotator cuff repair with PRP and 23 without. Platelet-rich plasma was prepared via plateletpheresis and applied in the form of a gel threaded to a suture and placed at the interface between tendon and bone. Outcomes were assessed preoperatively and at 3, 6, 12, and finally at a minimum of 16 months after surgery (at an average of 19.7 ± 1.9 months) with respect to pain, range of motion, strength, and overall satisfaction, and with respect to functional scores as determined using the following scoring systems: the American Shoulder and Elbow Surgeon (ASES) system, the Constant system, the University of California at Los Angeles (UCLA) system, the Disabilities of the Arm, Shoulder and Hand (DASH) system, the Simple Shoulder Test (SST) system, and the Shoulder Pain and Disability Index (SPADI) system. At a minimum of 9 months after surgery, repaired tendon structural integrities were assessed by magnetic resonance imaging.
Platelet-rich plasma gel application to arthroscopic rotator cuff repairs did not accelerate recovery with respect to pain, range of motion, strength, functional scores, or overall satisfaction as compared with conventional repair at any time point. Whereas magnetic resonance imaging demonstrated a retear rate of 26.7% in the PRP group and 41.2% in the conventional group, there was no statistical significance between the groups (P = .388).
The results suggest that PRP application during arthroscopic rotator cuff repair did not clearly demonstrate accelerated recovery clinically or anatomically except for an improvement in internal rotation. Nevertheless, as the study may have been underpowered to detect clinically important differences in the structural integrity, additional investigations, including the optimization of PRP preparation and a larger randomized study powered for healing rate, are necessary to further determine the effect of PRP.
富含血小板的血浆（PRP）最近已被用于增强和加速治疗肌肉骨骼损伤和疾病，但仍缺乏证据，尤其是在肩袖修复后的效果方面。
富含血小板的血浆可减轻疼痛、改善功能结果、提高整体满意度，并增强修复肌腱的结构完整性，从而加速关节镜下肩袖修复后的恢复。
队列研究；证据水平，2 级。
纳入 42 例全层肩袖撕裂患者。在手术前向患者介绍 PRP 的使用情况，并由患者自行决定是否在手术时放置 PRP。19 例患者接受关节镜下肩袖修复术+PRP，23 例患者接受关节镜下肩袖修复术+安慰剂。通过血小板分离术制备富含血小板的血浆，并将其制成凝胶，通过缝线将其穿入，并放置在肌腱和骨之间的界面处。在术前和术后 3、6、12 个月进行评估，最后在术后至少 16 个月（平均 19.7±1.9 个月）进行评估，评估内容包括疼痛、活动范围、力量和整体满意度，以及使用以下评分系统评估功能评分：美国肩肘外科医师协会（ASES）系统、Constant 系统、加利福尼亚大学洛杉矶分校（UCLA）系统、手臂、肩部和手部残疾指数（DASH）系统、简易肩部测试（SST）系统和肩痛和残疾指数（SPADI）系统。在术后至少 9 个月时，通过磁共振成像评估修复肌腱的结构完整性。
与常规修复相比，在任何时间点，富含血小板的血浆凝胶应用于关节镜下肩袖修复术并未在疼痛、活动范围、力量、功能评分或整体满意度方面加速恢复。尽管磁共振成像显示 PRP 组的再撕裂率为 26.7%，常规组为 41.2%，但两组之间无统计学意义（P=.388）。
结果表明，富含血小板的血浆在关节镜下肩袖修复术中的应用并未在临床上或解剖学上明显加速恢复，除了内旋改善外。然而，由于研究可能在结构完整性的临床重要差异方面检测能力不足，需要进一步的研究，包括优化 PRP 的制备和进行更大规模的、针对愈合率的随机研究，以进一步确定 PRP 的效果。
