Wang Allan, McCann Philip, Colliver Jess, Koh Eamon, Ackland Timothy, Joss Brendan, Zheng Minghao, Breidahl Bill
Department of Orthopaedic Surgery, University of Western Australia, Crawley, Australia
Department of Trauma and Orthopaedic Surgery, King Edward Building, Bristol Royal Infirmary, Bristol, UK.
Am J Sports Med. 2015 Jun;43(6):1430-7. doi: 10.1177/0363546515572602. Epub 2015 Mar 19.
Tendon-bone healing after rotator cuff repair directly correlates with a successful outcome. Biological therapies that elevate local growth-factor concentrations may potentiate healing after surgery.
To ascertain whether postoperative and repeated application of platelet-rich plasma (PRP) to the tendon repair site improves early tendon healing and enhances early functional recovery after double-row arthroscopic supraspinatus repair.
Randomized controlled trial; Level of evidence, 1.
A total of 60 patients underwent arthroscopic double-row supraspinatus tendon repair. After randomization, half the patients received 2 ultrasound-guided injections of PRP to the repair site at postoperative days 7 and 14. Early structural healing was assessed with MRI at 16 weeks, and cuff appearances were graded according to the Sugaya classification. Functional scores were recorded with the Oxford Shoulder Score; Quick Disability of the Arm, Shoulder and Hand; visual analog scale for pain; and Short Form-12 quality-of-life score both preoperatively and at postoperative weeks 6, 12, and 16; isokinetic strength and active range of motion were measured at 16 weeks.
PRP treatment did not improve early functional recovery, range of motion, or strength or influence pain scores at any time point after arthroscopic supraspinatus repair. There was no difference in structural integrity of the supraspinatus repair on MRI between the PRP group (0% full-thickness retear; 23% partial tear; 77% intact) and the control group (7% full-thickness retear; 23% partial tear; 70% intact) at 16 weeks postoperatively (P = .35).
After arthroscopic supraspinatus tendon repair, image-guided PRP treatment on 2 occasions does not improve early tendon-bone healing or functional recovery.
肩袖修复术后腱骨愈合与手术成功直接相关。提高局部生长因子浓度的生物疗法可能会增强术后愈合。
确定术后及反复向肌腱修复部位应用富血小板血浆(PRP)是否能改善关节镜下双排肩峰下肌腱修复术后的早期肌腱愈合并促进早期功能恢复。
随机对照试验;证据等级为1级。
共有60例患者接受了关节镜下双排肩峰下肌腱修复术。随机分组后,一半患者在术后第7天和第14天接受2次超声引导下的PRP注射至修复部位。在术后16周通过MRI评估早期结构愈合情况,并根据Sugaya分类法对肩袖外观进行分级。使用牛津肩部评分、手臂、肩部和手部快速残疾评估、疼痛视觉模拟量表以及术前和术后第6、12和16周的简短健康调查12项生活质量评分记录功能评分;在术后16周测量等速肌力和主动活动范围。
PRP治疗并未改善关节镜下肩峰下肌腱修复术后任何时间点的早期功能恢复、活动范围或力量,也未影响疼痛评分。术后16周,PRP组(全层再撕裂0%;部分撕裂23%;完整77%)和对照组(全层再撕裂7%;部分撕裂23%;完整70%)在MRI上肩峰下肌腱修复的结构完整性无差异(P = 0.35)。
关节镜下肩峰下肌腱修复术后,两次图像引导下的PRP治疗并不能改善早期腱骨愈合或功能恢复。