Ebert Jay R, Wang Allan, Smith Anne, Nairn Robert, Breidahl William, Zheng Ming Hao, Ackland Timothy
School of Human Sciences, The University of Western Australia, Perth, Western Australia, Australia.
Department of Orthopaedic Surgery, St John of God Subiaco Hospital, Perth, Western Australia, Australia.
Am J Sports Med. 2017 Nov;45(13):2965-2974. doi: 10.1177/0363546517719048. Epub 2017 Aug 14.
Platelet-rich plasma (PRP) has been applied as an adjunct to rotator cuff repair to improve tendon-bone healing and potentially reduce the incidence of subsequent tendon retears.
To investigate whether the midterm clinical and radiographic outcomes of arthroscopic supraspinatus repair are enhanced after repeated postoperative applications of PRP.
Randomized controlled trial; Level of evidence, 1.
A total of 60 patients (30 control; 30 PRP) were initially randomized to receive 2 ultrasound-guided injections of PRP to the tendon repair site at 7 and 14 days after double-row arthroscopic supraspinatus repair or not. A total of 55 patients (91.7%) underwent a clinical review and magnetic resonance imaging (MRI) at a mean of 3.5 years after surgery (range, 36-51 months). Patient-reported outcome measures (PROMs) included the Constant score, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire, Oxford Shoulder Score (OSS), and visual analog scale (VAS) for pain. Global rating of change (GRC) scale and patient satisfaction scores were evaluated. Structural integrity of the surgical repair was assessed via MRI using the Sugaya classification system.
At the midterm review, there was no difference between the groups for any of the PROMs. No differences between the groups were demonstrated for the subjective and range of motion subscales of the Constant score, although a significantly higher Constant strength subscale score was observed in the PRP group (3.3 points; 95% CI, 1.0-5.7; P = .006). There was no evidence for any group differences in MRI scores or retear rates, with 66.7% of PRP patients and 64.3% of control patients rated as Sugaya grade 1. Two control patients had symptomatic retears (both full thickness) within the first 16 weeks after surgery compared with 2 PRP patients, who suffered symptomatic retears (both partial thickness) between 16 weeks and a mean 3.5-year follow-up.
Significant postoperative clinical improvements and high levels of patient satisfaction were observed in patients at the midterm review after supraspinatus repair. While pain-free, maximal abduction strength was greater in the midterm after PRP treatment, repeated applications of PRP delivered at 7 and 14 days after surgery provided no additional benefit to tendon integrity.
富血小板血浆（PRP）已被用作肩袖修复的辅助手段，以促进肌腱-骨愈合，并可能降低随后肌腱再次撕裂的发生率。
探讨在关节镜下进行冈上肌修复术后重复应用PRP是否能改善中期临床和影像学结果。
随机对照试验；证据等级，1级。
总共60例患者（30例对照组；30例PRP组）最初被随机分为在双排关节镜下冈上肌修复术后7天和14天接受2次超声引导下向肌腱修复部位注射PRP或不接受注射。总共55例患者（91.7%）在术后平均3.5年（范围36-51个月）接受了临床复查和磁共振成像（MRI）。患者报告的结局指标（PROMs）包括Constant评分、手臂、肩部和手部快速残疾问卷（QuickDASH）、牛津肩部评分（OSS）以及疼痛视觉模拟量表（VAS）。评估了整体变化评分（GRC）量表和患者满意度得分。使用Sugaya分类系统通过MRI评估手术修复的结构完整性。
在中期复查时，各PROMs在两组之间均无差异。两组在Constant评分的主观和活动范围子量表上无差异，尽管PRP组的Constant力量子量表得分显著更高（3.3分；95%CI，1.0-5.7；P = 0.006）。在MRI评分或再次撕裂率方面没有证据表明两组之间存在差异，66.7%的PRP组患者和64.3%的对照组患者被评为Sugaya 1级。2例对照组患者在术后前16周内出现有症状的再次撕裂（均为全层），相比之下，2例PRP组患者在16周和平均3.5年随访之间出现有症状的再次撕裂（均为部分厚度）。
在中期复查时，冈上肌修复术后患者出现了显著的临床改善和较高的患者满意度。虽然PRP治疗后中期无痛，但最大外展力量更大，在术后7天和14天重复应用PRP对肌腱完整性没有额外益处。
