Evaluating the longitudinal efficacy of platelet-rich plasma in rotator cuff surgery: a systematic review and meta-analysis.

Rotator cuff (RC) tears affect 22% of the population, increasing with age. While 48.4% are asymptomatic, 25% require surgery. Annually, over 400,000 RC repairs (RCRs) are performed in the USA, costing over $50,000 each. However, retear rates remain high (10-40%), with clinical outcomes stagnating since 1980. Platelet-rich plasma (PRP) has emerged as a potential adjunct to RCR, with its growth factors and regenerative properties offering promise for enhancing tendon healing and improving postoperative outcomes. A comprehensive search across four major databases selected studies utilising PRP in RCR. Out of 2709 studies initially identified, 22 were included, with 13 undergoing meta-analysis. The primary outcome measures were pain and functional scores, with secondary outcomes including patient-reported outcome measures (PROMs) and retear rates. PRP significantly reduced VAS scores, as a proxy of pain reduction at 6 months (MD = 0.34 [0.10, 0.59]) and at 12 months (MD = 0.24 [0.03, 0.44]) post-RCR. UCLA score improvements were significant at 3 months (MD = 2.98 [1.55, 4.40]), 6 months (MD = 1.96 [1.09, 2.83]) and 12 months (MD = 1.26 [0.39, 2.13]). Additionally, PRP significantly reduced retear rates at 24 months, with a mean risk reduction of 15.03%, indicating a substantial improvement in tendon healing. PRP offers substantial benefits in RCR, particularly in reducing pain and retear rates. However, further research is necessary due to observed heterogeneity and study biases. Future efforts should focus on incorporating PRP into clinical practice and guidelines.