Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois, USA.
Arthroscopy. 2012 Nov;28(11):1718-27. doi: 10.1016/j.arthro.2012.03.007. Epub 2012 Jun 12.
Despite the theoretic basis and interest in using platelet-rich plasma (PRP) to improve the potential for rotator cuff healing, there remains ongoing controversy regarding its clinical efficacy. The objective of this systematic review was to identify and summarize the available evidence to compare the efficacy of arthroscopic rotator cuff repair in patients with full-thickness rotator cuff tears who were concomitantly treated with PRP.
We searched the Cochrane Central Register of Controlled Trials, Medline, Embase, and PubMed for eligible studies. Two reviewers selected studies for inclusion, assessed methodologic quality, and extracted data. Pooled analyses were performed using a random effects model to arrive at summary estimates of treatment effect with associated 95% confidence intervals.
Five studies (2 randomized and 3 nonrandomized with comparative control groups) met the inclusion criteria, with a total of 261 patients. Methodologic quality was uniformly sound as assessed by the Detsky scale and Newcastle-Ottawa Scale. Quantitative synthesis of all 5 studies showed that there was no statistically significant difference in the overall rate of rotator cuff retear between patients treated with PRP and those treated without PRP (risk ratio, 0.77; 95% confidence interval, 0.48 to 1.23). There were also no differences in the pooled Constant score; Simple Shoulder Test score; American Shoulder and Elbow Surgeons score; University of California, Los Angeles shoulder score; or Single Assessment Numeric Evaluation score.
PRP does not have an effect on overall retear rates or shoulder-specific outcomes after arthroscopic rotator cuff repair. Additional well-designed randomized trials are needed to corroborate these findings.
Level III, systematic review of Level I, II, and III studies.
尽管使用富含血小板的血浆（PRP）来提高肩袖愈合潜力的理论基础和兴趣，但关于其临床疗效仍存在持续争议。本系统评价的目的是确定和总结现有证据，以比较同时接受 PRP 治疗的全层肩袖撕裂患者关节镜肩袖修复的疗效。
我们搜索了 Cochrane 对照试验中心注册库、Medline、Embase 和 PubMed，以确定符合条件的研究。两名审查员选择纳入研究，评估方法学质量，并提取数据。使用随机效应模型进行汇总分析，得出治疗效果的综合估计值及其相关 95％置信区间。
符合纳入标准的有 5 项研究（2 项随机对照研究和 3 项具有可比性的非随机对照研究），共有 261 名患者。根据 Detsky 量表和纽卡斯尔-渥太华量表评估，方法学质量均一致良好。对所有 5 项研究的定量综合分析表明，接受 PRP 治疗和未接受 PRP 治疗的患者肩袖再撕裂的总体发生率无统计学差异（风险比，0.77；95％置信区间，0.48 至 1.23）。在聚合的 Constant 评分、简单肩部测试评分、美国肩肘外科医生评分、加利福尼亚大学洛杉矶分校肩部评分或单一评估数字评估评分方面也没有差异。
PRP 对关节镜肩袖修复后的总体再撕裂率或肩部特定结局没有影响。需要进行更多设计良好的随机试验来证实这些发现。
III 级，对 I、II 和 III 级研究的系统评价。
