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Shen Z, Ye X, He Y, Shen G, Xu K, Zhang B, Wu L. Arthroscopic rotator cuff repair combined with platelet-rich plasma products can reduce the rate of retearing and improve clinical outcomes: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2024; 103:e38069. [PMID: 38701265 PMCID: PMC11062711 DOI: 10.1097/md.0000000000038069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 04/10/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Although several studies on the potential benefits of protein-rich plasma (PRP) therapy for rotator cuff injuries have been published, the results have been conflicting. Therefore, this study aimed to determine whether PRP is beneficial for the prevention of retears after arthroscopic rotator cuff repair (ARCR). METHODS Two reviewers conducted independent literature searches based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomized controlled trials (RCTs) comparing a PRP treatment group with a control group were included. The quality of evidence was assessed using the Cochrane Collaboration Risk of Bias Tool. Clinical outcomes were compared using the risk ratio (RR) for dichotomous variables and weighted mean difference (WMD) for continuous variables. Statistical significance was set at P < .05. RESULTS This review included 21 RCTs (1359 patients). Significant results were noted in favor of PRP treatment compared with controls based on retearing rates (16.5% vs 23.6%, respectively; P = .002) and the Constant score in the short term (WMD: 1.98; 95% confidence interval [CI], 0.27-3.70; I2 = 0%; P = .02), medium term and long term (WMD: 2.56 [95% CI: 1.57-3.55]; I2 = 2%; P < .001); the University of California, Los Angeles score in the short term (WMD: 1.14 [95% CI: 0.43-1.85]; I2 = 25%; P = .002) but not in the medium and long term (WMD: 0.66 [95% CI: -0.16 to 1.48]; I2 = 57%; P = .11); and the visual analog scale score in the short term (WMD: -0.63 [95% CI: -0.83 to-0.43]; I2 = 41%; P < .001), medium and long term (WMD: -0.12 [95% CI: -0.19 to-0.05]; I2 = 0%; P = .008). There was no significant difference in American Shoulder and Elbow Surgeons scores between the treatment and control groups in the short term (WMD: -0.48 [95% CI: -2.80 to 1.85]; I2 = 22%; P = .69) or medium and long term (WMD: 0.92 [95% CI: -1.56 to 3.39]; I2 = 40%; P = .47). CONCLUSION Intraoperative use of PRP reduces the risk of rotator cuff repair failure, improves clinical outcomes, and reduces recurrence rates.
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Affiliation(s)
- Zhe Shen
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Xiaoang Ye
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Yawen He
- Hangzhou Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Gaobo Shen
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Kuangying Xu
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Bingbing Zhang
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Lianguo Wu
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
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Bahadir B, Sarikaya B. Platelet-rich plasma in the management of rotator cuff tendinopathy. Jt Dis Relat Surg 2024; 35:462-467. [PMID: 38727130 PMCID: PMC11128950 DOI: 10.52312/jdrs.2024.1586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 01/28/2024] [Indexed: 05/24/2024] Open
Abstract
Platelet-rich plasma (PRP) is an autologous blood-derived product that has gained significant attention in the treatment of tendinopathies as one of many treatment modalities in the field of regenerative medicine. Rotator cuff pathologies are the leading cause of shoulder pain. Despite the high success rate with conservative treatment and arthroscopic surgical repair, the search for a nonsurgical treatment has made PRP a trending topic recently. The purpose of this article is to review the recent literature data on the possible role of PRP in different rotator cuff pathologies. The limited data in the literature about isolated tendinopathies without a tear (tendonitis and tendinosis) suggests potential benefit from conservative treatment with PRP. Many studies exist for the treatment of rotator cuff tears solely using PRP or as an augmentation to arthroscopic repair. Despite the large number of randomized clinical trials and meta-analyses about the topic, there is no consensus in favor of routine application of PRP in this patient population. The existing reliable evidence of benefit seems to be restricted to its use in only inflammatory tendinopathies with preserved tendon integrity.
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Affiliation(s)
- Batuhan Bahadir
- Ankara Bilkent Şehir Hastanesi, Ortopedi ve Travmatoloji Kliniği, 06800 Çankaya, Ankara, Türkiye.
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Moulton SG, Hartwell MJ, Feeley BT. Evaluation of Spin Bias in Systematic Reviews and Meta-analyses of Rotator Cuff Repair With Platelet-Rich Plasma. Am J Sports Med 2024:3635465231213039. [PMID: 38323324 DOI: 10.1177/03635465231213039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
BACKGROUND The use of platelet-rich plasma (PRP) in orthopaedics continues to increase. One common use of PRP is as an adjunct in rotator cuff repair surgery. Multiple systematic reviews and meta-analyses have summarized the data on PRP use in rotator cuff repair surgery. However, systematic reviews and meta-analyses are subject to spin bias, where authors' interpretations of results influence readers' interpretations. PURPOSE To evaluate spin in the abstracts of systematic reviews and meta-analyses of PRP with rotator cuff repair surgery. STUDY DESIGN Systematic review; Level of evidence, 3. METHODS A PubMed and Embase search was conducted using the terms rotator cuff repair and PRP and systematic review or meta-analysis. After review of 74 initial studies, 25 studies met the inclusion criteria. Study characteristics were documented, and each study was evaluated for the 15 most common forms of spin and using the AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews, Version 2) rating system. Correlations between spin types and study characteristics were evaluated using binary logistic regression for continuous independent variables and a chi-square test or Fisher exact test for categorical variables. RESULTS At least 1 form of spin was found in 56% (14/25) of the included studies. In regard to the 3 different categories of spin, a form of misleading interpretation was found in 56% (14/25) of the studies. A form of misleading reporting was found in 48% (12/25) of the studies. A form of inappropriate extrapolation was found in 16% (4/25) of the studies. A significant association was found between misleading interpretation and publication year (odds ratio [OR], 1.41 per year increase in publication; 95% CI, 1.04-1.92; P = .029) and misleading reporting and publication year (OR, 1.41 per year increase in publication; 95% CI, 1.02-1.95; P = .037). An association was found between inappropriate extrapolation and journal impact factor (OR, 0.21 per unit increase in impact factor; 95% CI, 0.044-0.99; P = .048). CONCLUSION A significant amount of spin was found in the abstracts of systematic reviews and meta-analyses of PRP use in rotator cuff repair surgery. Given the increasing use of PRP by clinicians and interest among patients, spin found in these studies may have a significant effect on clinical practice.
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Affiliation(s)
- Samuel G Moulton
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Matthew J Hartwell
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Brian T Feeley
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
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Vasalou V, Kotidis E, Tatsis D, Boulogeorgou K, Grivas I, Koliakos G, Cheva A, Ioannidis O, Tsingotjidou A, Angelopoulos S. The Effects of Tissue Healing Factors in Wound Repair Involving Absorbable Meshes: A Narrative Review. J Clin Med 2023; 12:5683. [PMID: 37685753 PMCID: PMC10488606 DOI: 10.3390/jcm12175683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/17/2023] [Accepted: 08/26/2023] [Indexed: 09/10/2023] Open
Abstract
Wound healing is a complex and meticulously orchestrated process involving multiple phases and cellular interactions. This narrative review explores the intricate mechanisms behind wound healing, emphasizing the significance of cellular processes and molecular factors. The phases of wound healing are discussed, focusing on the roles of immune cells, growth factors, and extracellular matrix components. Cellular shape alterations driven by cytoskeletal modulation and the influence of the 'Formin' protein family are highlighted for their impact on wound healing processes. This review delves into the use of absorbable meshes in wound repair, discussing their categories and applications in different surgical scenarios. Interleukins (IL-2 and IL-6), CD31, CD34, platelet rich plasma (PRP), and adipose tissue-derived mesenchymal stem cells (ADSCs) are discussed in their respective roles in wound healing. The interactions between these factors and their potential synergies with absorbable meshes are explored, shedding light on how these combinations might enhance the healing process. Recent advances and challenges in the field are also presented, including insights into mesh integration, biocompatibility, infection prevention, and postoperative complications. This review underscores the importance of patient-specific factors and surgical techniques in optimizing mesh placement and healing outcomes. As wound healing remains a dynamic field, this narrative review provides a comprehensive overview of the current understanding and potential avenues for future research and clinical applications.
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Affiliation(s)
- Varvara Vasalou
- Fourth Surgical Department, School of Medicine, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
- Andreas Syggros Hospital, 11528 Athens, Greece
| | - Efstathios Kotidis
- Fourth Surgical Department, School of Medicine, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
| | - Dimitris Tatsis
- Fourth Surgical Department, School of Medicine, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
- Oral and Maxillofacial Surgery Department, School of Dentistry, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
| | - Kassiani Boulogeorgou
- Department of Pathology, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (K.B.)
| | - Ioannis Grivas
- Laboratory of Anatomy, Histology & Embryology, School of Veterinary Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Georgios Koliakos
- Department of Biochemistry, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Angeliki Cheva
- Department of Pathology, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (K.B.)
| | - Orestis Ioannidis
- Fourth Surgical Department, School of Medicine, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
| | - Anastasia Tsingotjidou
- Laboratory of Anatomy, Histology & Embryology, School of Veterinary Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Stamatis Angelopoulos
- Fourth Surgical Department, School of Medicine, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
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You T, Wu S, Ou X, Liu Y, Wang X. A network meta-analysis of arthroscopic rotator cuff repair. BMC Surg 2023; 23:201. [PMID: 37443010 DOI: 10.1186/s12893-023-02078-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 06/14/2023] [Indexed: 07/15/2023] Open
Abstract
OBJECTIVE Rotator cuff tear is a common shoulder injury that often leads to serious limitations in daily life. Herein, a network Meta-analysis using frequency theory was performed to evaluate the clinical outcomes of five rotator cuff repair techniques, including single-row repair, double-row repair, suture bridge repair, platelet-rich plasma therapy, and bone marrow stimulation, thus guiding clinical decision-making on rotator cuff repair. METHODS PubMed, EMbase, The Cochrane Library, and Web of Science were searched for randomized controlled trials and cohort studies comparing rotator cuff repair techniques published from inception to May 2022. Combined analysis and quality assessment were performed using software STATA15.1 and Review Manager5.3. RESULTS A total of 51 articles were finally included, including 27 randomized controlled trials and 24 cohort studies. Results from the network Meta-analysis showed that: (1) In terms of the American Shoulder and Elbow Surgeons score, platelet-rich plasma therapy, double-row repair, bone marrow stimulation, and single-row repair were significantly better than suture bridge repair. (2) In terms of Constant score, bone marrow stimulation was significantly better than double-row repair, single-row repair, and suture bridge repair. (3) In terms of visual analog scale score, platelet-rich plasma therapy was significantly better than double-row repair and suture bridge repair. (4) In terms of the Shoulder Rating Scale of the University of California at Los Angeles score, platelet-rich plasma therapy and double-row repair were relatively better but not significantly different from the other treatments. (5) In terms of the risk of re-tear, the re-tear rate of platelet-rich plasma therapy and double-row repair was significantly lower than that of single-row repair and suture bridge repair. CONCLUSION Based on the results of network Meta-analysis and surface under the cumulative ranking, platelet-rich plasma therapy, bone marrow stimulation, and double-row repair have good overall rehabilitation effects. It is recommended to choose appropriate repair techniques as per the actual clinical situation.
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Affiliation(s)
- Tianshu You
- School of Electrical Engineering and Computer, Jilin Jianzhu University, Changchun, Jilin Province, China
| | - Siyu Wu
- Department of Hand Surgery, the Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Xiaolan Ou
- Department of Hand Surgery, the Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Ying Liu
- Department of Cardiology, Jilin Province Hospital, Changchun, Jilin Province, China
| | - Xu Wang
- School of Electrical Engineering and Computer, Jilin Jianzhu University, Changchun, Jilin Province, China.
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Morgan CN, Bonner KF, Griffin JW. Augmentation of Arthroscopic Rotator Cuff Repair: Biologics and Grafts. Clin Sports Med 2023; 42:95-107. [DOI: 10.1016/j.csm.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Wang D, Zhang X, Ng KW, Rao Y, Wang C, Gharaibeh B, Lin S, Abrams G, Safran M, Cheung E, Campbell P, Weiss L, Ker DFE, Yang YP. Growth and differentiation factor-7 immobilized, mechanically strong quadrol-hexamethylene diisocyanate-methacrylic anhydride polyurethane polymer for tendon repair and regeneration. Acta Biomater 2022; 154:108-122. [PMID: 36272687 DOI: 10.1016/j.actbio.2022.10.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 10/13/2022] [Accepted: 10/13/2022] [Indexed: 12/14/2022]
Abstract
Biological and mechanical cues are both vital for biomaterial aided tendon repair and regeneration. Here, we fabricated mechanically tendon-like (0 s UV) QHM polyurethane scaffolds (Q: Quadrol, H: Hexamethylene diisocyanate; M: Methacrylic anhydride) and immobilized them with Growth and differentiation factor-7 (GDF-7) to produce mechanically strong and tenogenic scaffolds. In this study, we assessed QHM polymer cytocompatibility, amenability to fibrin-coating, immobilization and persistence of GDF-7, and capability to support GDF-7-mediated tendon differentiation in vitro as well as in vivo in mouse subcutaneous and acute rat rotator cuff tendon resection models. Cytocompatibility studies showed that QHM facilitated cell attachment, proliferation, and viability. Fibrin-coating and GDF-7 retention studies showed that mechanically tendon-like 0 s UV QHM polymer could be immobilized with GDF-7 and retained the growth factor (GF) for at least 1-week ex vivo. In vitro differentiation studies showed that GDF-7 mediated bone marrow-derived human mesenchymal stem cell (hMSC) tendon-like differentiation on 0 s UV QHM. Subcutaneous implantation of GDF-7-immobilized, fibrin-coated, QHM polymer in mice for 2 weeks demonstrated de novo formation of tendon-like tissue while implantation of GDF-7-immobilized, fibrin-coated, QHM polymer in a rat acute rotator cuff resection injury model indicated tendon-like tissue formation in situ and the absence of heterotopic ossification. Together, our work demonstrates a promising synthetic scaffold with human tendon-like biomechanical attributes as well as immobilized tenogenic GDF-7 for tendon repair and regeneration. STATEMENT OF SIGNIFICANCE: Biological activity and mechanical robustness are key features required for tendon-promoting biomaterials. While synthetic biomaterials can be mechanically robust, they often lack bioactivity. To biologically augment synthetic biomaterials, numerous drug and GF delivery strategies exist but the large tissue space within the shoulder is constantly flushed with saline during arthroscopic surgery, hindering efficacious controlled release of therapeutic molecules. Here, we coated QHM polymer (which exhibits human tendon-to-bone-like biomechanical attributes) with fibrin for GF binding. Unlike conventional drug delivery strategies, our approach utilizes immobilized GFs as opposed to released GFs for sustained, localized tissue regeneration. Our data demonstrated that GF immobilization can be broadly applied to synthetic biomaterials for enhancing bioactivity, and GDF-7-immobilized QHM exhibit high clinical translational potential for tendon repair.
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Affiliation(s)
- Dan Wang
- Department of Orthopaedic Surgery, Stanford University, 240 Pasteur Drive, Stanford, CA 94304, USA; Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; Ministry of Education Key Laboratory for Regenerative Medicine, School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Center for Neuromuscular Restorative Medicine, Hong Kong Science Park, Hong Kong SAR, China
| | - Xu Zhang
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ka Wai Ng
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ying Rao
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chenyang Wang
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Burhan Gharaibeh
- Department of Biological Sciences, University of Pittsburgh, 4249 Fifth Avenue, Pittsburgh, PA 15260, USA
| | - Sien Lin
- Department of Orthopaedic Surgery, Stanford University, 240 Pasteur Drive, Stanford, CA 94304, USA; Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Geoffrey Abrams
- Department of Orthopaedic Surgery, Stanford University, 240 Pasteur Drive, Stanford, CA 94304, USA
| | - Marc Safran
- Department of Orthopaedic Surgery, Stanford University, 240 Pasteur Drive, Stanford, CA 94304, USA
| | - Emilie Cheung
- Department of Orthopaedic Surgery, Stanford University, 240 Pasteur Drive, Stanford, CA 94304, USA
| | - Phil Campbell
- Engineering Research Accelerator, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA 15213, USA; Department of Biomedical Engineering, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA 15213, USA; Robotics Institute, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA 15213, USA
| | - Lee Weiss
- Robotics Institute, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA 15213, USA; Engineering Research Accelerator, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA 15213, USA; Department of Biomedical Engineering, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA 15213, USA
| | - Dai Fei Elmer Ker
- Department of Orthopaedic Surgery, Stanford University, 240 Pasteur Drive, Stanford, CA 94304, USA; Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; Ministry of Education Key Laboratory for Regenerative Medicine, School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Center for Neuromuscular Restorative Medicine, Hong Kong Science Park, Hong Kong SAR, China.
| | - Yunzhi Peter Yang
- Department of Orthopaedic Surgery, Stanford University, 240 Pasteur Drive, Stanford, CA 94304, USA; Department of Material Science and Engineering, Stanford University, 496 Lomita Mall, Stanford, CA 94305, USA; Department of Bioengineering, Stanford University, 443 Via Ortega, Stanford, CA 94305, USA.
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Bajaj S, Orbuch D, Wang JV, Geronemus RG. Preparation and Utility of Platelet-Rich Plasma (PRP) for Facial Aging: A Comprehensive Review. Adv Ther 2022; 39:4021-4036. [DOI: 10.1007/s12325-022-02239-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/22/2022] [Indexed: 11/30/2022]
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Muthu S, Jeyaraman N, Patel K, Chellamuthu G, Viswanathan VK, Jeyaraman M, Khanna M. Evidence analysis on the utilization of platelet-rich plasma as an adjuvant in the repair of rotator cuff tears. World J Meta-Anal 2022; 10:143-161. [DOI: 10.13105/wjma.v10.i3.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 03/23/2022] [Accepted: 06/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Platelet-rich plasma has been gaining popularity as an agent for biological augmentation either as the sole treatment modality or as an adjunct to surgical repair. There is substantial discrepancy in the results of the published meta-analyses; and the true efficacy and role of using autologous platelet-rich plasma (PRP) at the time of rotator cuff repair is still ambiguous.
AIM To performed this systematic overview on the overlapping meta-analyses that analyzed autologous PRP as an adjuvant in the repair of rotator cuff tears and identify the studies which provide the current best evidence on this subject and generate recommendations for the same.
METHODS We conducted independent and duplicate electronic database searches in PubMed, Web of Science, Scopus, Embase, Cochrane Database of Systematic Reviews, Reference Citation Analysis and the Database of Abstracts of Reviews of Effects on September 8, 2021 to identify meta-analyses that analyzed the efficacy of PRP as an adjuvant in the repair of rotator cuff tears. Methodological quality assessment was made using Oxford Levels of Evidence, AMSTAR scoring and AMSTAR 2 grades. We then utilized the Jadad decision algorithm to identify the study with the highest quality to represent the current best evidence to generate the recommendation.
RESULTS Twenty meta-analyses fulfilling the eligibility criteria were included. The AMSTAR scores of the included studies varied from 6-10 (mean: 7.9). All the included studies had critically low reliability in their summary of results due to their methodological flaws according to AMSTAR 2 grades. Significant heterogeneity was observed in the reporting of VAS, function outcome scores (long-term UCLA score, ASES score, SST score), operative time and long-term re-tear rates. Recent meta-analyses are more supportive of the role of intra-operative administration of PRPs at the bone-tendon interface in improving the overall healing and re-tear rates, functional outcome and pain. The initial size of the tear and type of repair performed do not seem to affect the benefit of PRPs. Among the different preparations used, leucocyte poor (LP)-PRP possibly offers the greatest benefit as a biological augment in these situations.
CONCLUSION Based on this systematic overview, we give a level II recommendation that intra-operative use of PRPs at the bone-tendon interface can augment the healing rate, reduce re-tears, enhance functional outcome and mitigate pain in patients undergoing arthroscopic rotator cuff repair. LP-PRP possibly offers the greatest benefit in terms of healing rates, as compared with other platelet preparations.
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Affiliation(s)
- Sathish Muthu
- Department of Orthopaedics, Government Medical College and Hospital, Dindigul 624001, Tamil Nadu, India
- Department of Biotechnology, School of Engineering and Technology, Sharda University, Greater Noida 201306, Uttar Pradesh, India
- Research Associate, Indian Stem Cell Study GroupAssociation, Lucknow 226010, Uttar Pradesh, India
- Research Associate, Orthopaedic Research Group, Coimbatore 641001, Tamil Nadu, India
| | - Naveen Jeyaraman
- Research Associate, Indian Stem Cell Study GroupAssociation, Lucknow 226010, Uttar Pradesh, India
- Research Associate, Orthopaedic Research Group, Coimbatore 641001, Tamil Nadu, India
- Fellow in Orthopaedic Rheumatology, Dr Ram Manohar Lohiya National Law University, Lucknow 226010, Uttar Pradesh, India
- Fellow in Joint Replacement, Atlas Hospitals (The Tamil Nadu Dr MGR Medical University), Tiruchirappalli 620002, Tamil Nadu, India
| | - Keval Patel
- Research Associate, Indian Stem Cell Study GroupAssociation, Lucknow 226010, Uttar Pradesh, India
- Fellow in Orthopaedic Rheumatology, Dr Ram Manohar Lohiya National Law University, Lucknow 226010, Uttar Pradesh, India
| | - Girinivasan Chellamuthu
- Research Associate, Indian Stem Cell Study GroupAssociation, Lucknow 226010, Uttar Pradesh, India
- Research Associate, Orthopaedic Research Group, Coimbatore 641001, Tamil Nadu, India
- Fellow in Arthroscopy, Ortho-One Orthopaedic Speciality Centre (The Tamil Nadu Dr MGR Medical University), Coimbatore 641005, Tamil Nadu, India
| | - Vibhu Krishnan Viswanathan
- Department of Orthopaedics and Spine Surgery, Ganga Medical Centre and Hospitals, Coimbatore 641043, Tamil Nadu, India
| | - Madhan Jeyaraman
- Department of Biotechnology, School of Engineering and Technology, Sharda University, Greater Noida 201306, Uttar Pradesh, India
- Research Associate, Indian Stem Cell Study GroupAssociation, Lucknow 226010, Uttar Pradesh, India
- Research Associate, Orthopaedic Research Group, Coimbatore 641001, Tamil Nadu, India
- Department of Orthopaedics, Faculty of Medicine, Sri Lalithambigai Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai 600095, Tamil Nadu, India
- South Texas Orthopaedic Research Institute, Laredo, TX 78045, United States
| | - Manish Khanna
- Research Associate, Indian Stem Cell Study GroupAssociation, Lucknow 226010, Uttar Pradesh, India
- Research Associate, Orthopaedic Research Group, Coimbatore 641001, Tamil Nadu, India
- Department of Orthopaedics, Autonomous State Medical College, Ayodhya 224135, Uttar Pradesh, India
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10
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Platelet-Rich Plasma Has Better Results for Retear Rate, Pain, and Outcome Than Platelet-Rich Fibrin After Rotator Cuff Repair: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Arthroscopy 2022; 38:539-550. [PMID: 34052384 DOI: 10.1016/j.arthro.2021.05.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 05/02/2021] [Accepted: 05/15/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE To perform a systematic review and meta-analysis of randomized controlled trials (RCTs) in the literature to ascertain the extent to which platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) improved patient outcomes in arthroscopic rotator cuff repair. METHODS Two independent reviewers performed the literature search based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, with a third author resolving any discrepancies. RCTs comparing PRP or PRF to a control in rotator cuff repair were included. Quality of evidence was assessed using the Cochrane Collaboration risk of bias tool. Clinical outcomes were compared using the risk ratio for dichotomous variables and the mean difference for continuous variables. A P value <.05 was deemed statistically significant. RESULTS Included in this review are 23 RCTs with 1440 patients. PRP resulted in significantly decreased rates of retear (15.9% versus 29.0%, respectively; P < .0001). Significant results were noted in favor of PRP compared with control based on the Constant score (83.9 versus 81.2, respectively; P = .0006); the University of California, Los Angeles score (31.1 versus 30.2; P < .00001); the American Shoulder and Elbow Surgeons score (87.3 versus 84.5; P = .04); and the visual analog scale score (1.3 versus 1.6; P = .01). PRF resulted in an improved Constant score (80.1 versus 80.0, respectively; P = .04) compared with control. CONCLUSIONS The current evidence shows that using PRP in arthroscopic rotator cuff repair can improve pain levels and functional outcome scores while reducing the retear rate after surgery. PRF injection, on the other hand, improves only the Constant score. LEVEL OF EVIDENCE II; systematic review and meta-analysis of level I and II evidence.
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DeClercq MG, Fiorentino AM, Lengel HA, Ruzbarsky JJ, Robinson SK, Oberlohr VT, Whitney KE, Millett PJ, Huard J. Systematic Review of Platelet-Rich Plasma for Rotator Cuff Repair: Are We Adhering to the Minimum Information for Studies Evaluating Biologics in Orthopaedics? Orthop J Sports Med 2021; 9:23259671211041971. [PMID: 34901286 PMCID: PMC8655472 DOI: 10.1177/23259671211041971] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 05/19/2021] [Indexed: 01/08/2023] Open
Abstract
Background The therapeutic efficacy of orthobiologic therapies for rotator cuff repair is difficult to evaluate owing to reporting inconsistences. In response, the Minimum Information for Studies Evaluating Biologics in Orthopaedics (MIBO) guidelines were developed to ensure standard reporting on orthobiologic therapies. Purpose To systematically review clinical studies evaluating platelet-rich plasma (PRP) for full-thickness rotator cuff repair and adherence to MIBO guidelines. Study Design Scoping review; Level of evidence, 4. Methods A search was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using PubMed, EMBASE, and the Cochrane Library databases. Inclusion criteria were clinical studies reporting on rotator cuff tears (≥1 cm) surgically repaired with PRP. Patient demographics, biologic intervention, and adherence to the MIBO guidelines were systematically reviewed. Results A total of 19 studies (1005 patients) were included in this review. Across all studies, 58.5% of the MIBO checklist items for PRP were reported. Out of 47 checklist items, 19 were reported in over 85% of studies, whereas 22 were reported in less than half of studies. Details of whole-blood processing and characteristics, as well as PRP processing and characteristics, were reported inconsistently, and no study provided adequate information to enable the precise replication of preparation protocols for PRP. Conclusion This systematic review highlights the current reporting deficiencies within the scientific literature of important variables for evaluating PRP for full-thickness rotator cuff repair. There was widespread variability among published studies that evaluate PRP for this application and, more specifically, studies were limited by inconsistent universal reporting of whole-blood and PRP processing and postprocessing characteristics. To improve our understanding of biologic efficacy and to promote repeatability, stricter adherence to the MIBO guidelines is necessary. We propose that the checklist limitations be addressed and that modification of the MIBO guidelines be considered to improve the reporting of individual components within certain categories.
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Affiliation(s)
- Madeleine G DeClercq
- Center for Regenerative Sports Medicine, Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Alyson M Fiorentino
- Center for Regenerative Sports Medicine, Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | | | - Sara K Robinson
- Center for Regenerative Sports Medicine, Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Verena T Oberlohr
- Center for Regenerative Sports Medicine, Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Kaitlyn E Whitney
- Center for Regenerative Sports Medicine, Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | - Johnny Huard
- Center for Regenerative Sports Medicine, Steadman Philippon Research Institute, Vail, Colorado, USA
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Chen RJ, Zhu HZ, Gu XY, Xiang XX. Effects of Platelet-Rich Plasma on Tendon-Bone Healing After Anterior Cruciate Ligament Reconstruction. Orthop Surg 2021; 14:88-95. [PMID: 34870370 PMCID: PMC8755887 DOI: 10.1111/os.13175] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 10/05/2021] [Accepted: 10/20/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To investigate the effect of platelet-rich plasma on tendon-bone healing after anterior cruciate ligament reconstruction. METHODS This retrospective study included 85 patients (range, 18-50 years; mean age, 33.95 ± 10.53 years; male/female, 49/36) who underwent anterior cruciate ligament reconstruction using autologous hamstring tendons between August 2017 and June 2019 at our institute. The participants in the study group (n = 42) were injected with platelet-rich plasma at both ends of the tendon graft, while those in the control group (n = 43) received an injection of normal saline. Magnetic resonance imaging signal/noise quotient values of the femoral and tibial ends, knee Lysholm scores, and International Knee Documentation Committee scores were compared at 3, 6, and 12 months postoperatively. RESULTS The signal/noise quotient values of the femoral and tibial ends in both groups were higher at 6 months than at 3 and 12 months postoperatively. The signal/noise quotient values of the tibial end were significantly lower in the platelet-rich plasma group than in the normal saline group at all follow-up time points (P < 0.05). The signal/noise quotient values of the tibial and femoral ends in both groups were significantly different at 3, 6, and 12 months postoperatively (P < 0.05). Additionally, the signal/noise quotient values of the tibia were significantly lower than those of the femur in both groups (P < 0.05). The Lysholm and International Knee Documentation Committee scores were significantly better in the platelet-rich plasma group than in the normal saline group only at 3 months postoperatively. No complications, such as knee joint infection or vascular and nerve injuries, occurred in any of the 85 patients. The knee flexion of all patients were more than 90°, and the straight degree was 0°. No joint stiffness was observed in all patients. CONCLUSION Platelet-rich plasma can promote tendon-bone healing in grafts and can improve early postoperative knee joint function.
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Affiliation(s)
- Rong-Jin Chen
- Department of Orthopedic Surgery, Affiliated Sichuan Provincial Rehabilitation Hospital of Chengdu University of TCM, Chengdu, China.,Department of Orthopedic Surgery, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Hao-Zhong Zhu
- Department of Orthopedic Surgery, Chengdu Fifth People's Hospital, Chengdu, China
| | - Xin-Yi Gu
- Department of Oncology, Chengdu Fifth People's Hospital, Chengdu, China
| | - Xian-Xiang Xiang
- Department of Orthopedic Surgery, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
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Solomon DJ. Editorial Commentary: Leukocyte-Poor Platelet-Rich Plasma Decreases Retear Rate in Arthroscopic Rotator Cuff Repair: Platelet-Rich Plasma Type Matters. Arthroscopy 2021; 37:2625-2626. [PMID: 34353565 DOI: 10.1016/j.arthro.2021.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 02/02/2023]
Abstract
Numerous studies, including several meta-analysis reviews of platelet-rich plasma (PRP) in the setting of arthroscopic rotator cuff repair, show mixed results. Focusing on specific types of PRP configuration may elucidate which provide value and which do not. Recent meta-analysis demonstrates that leukocyte-poor PRP or "pure PRP" treatment is shown to decrease retear rate and patient-reported outcome measures after arthroscopic rotator cuff repair of the shoulder. Meta-analyses resulting in conflicting results may be attributed to different study inclusion and exclusion criteria and date of search.
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Bianchi E, Ruggeri M, Rossi S, Vigani B, Miele D, Bonferoni MC, Sandri G, Ferrari F. Innovative Strategies in Tendon Tissue Engineering. Pharmaceutics 2021; 13:89. [PMID: 33440840 PMCID: PMC7827834 DOI: 10.3390/pharmaceutics13010089] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/31/2020] [Accepted: 01/08/2021] [Indexed: 12/15/2022] Open
Abstract
The tendon is a highly aligned connective tissue that transmits force from muscle to bone. Each year, more than 32 million tendon injuries have been reported, in fact, tendinopathies represent at least 50% of all sports injuries, and their incidence rates have increased in recent decades due to the aging population. Current clinical grafts used in tendon treatment are subject to several restrictions and there is a significant demand for alternative engineered tissue. For this reason, innovative strategies need to be explored. Tendon replacement and regeneration are complex since scaffolds need to guarantee an adequate hierarchical structured morphology and mechanical properties to stand the load. Moreover, to guide cell proliferation and growth, scaffolds should provide a fibrous network that mimics the collagen arrangement of the extracellular matrix in the tendons. This review focuses on tendon repair and regeneration. Particular attention has been devoted to the innovative approaches in tissue engineering. Advanced manufacturing techniques, such as electrospinning, soft lithography, and three-dimensional (3D) printing, have been described. Furthermore, biological augmentation has been considered, as an emerging strategy with great therapeutic potential.
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Affiliation(s)
| | | | | | | | | | | | - Giuseppina Sandri
- Department of Drug Sciences, University of Pavia, Viale Taramelli 12, 27100 Pavia, Italy; (E.B.); (M.R.); (S.R.); (B.V.); (D.M.); (M.C.B.); (F.F.)
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Everts PA, van Erp A, DeSimone A, Cohen DS, Gardner RD. Platelet Rich Plasma in Orthopedic Surgical Medicine. Platelets 2021; 32:163-174. [PMID: 33400591 DOI: 10.1080/09537104.2020.1869717] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
There is a global interest in optimizing post-surgical tissue repair strategies, leading to better patient outcomes and fewer complications, most ideally with reduced overall cost. In this regard, in recent years, the interest in autologous biological treatments in orthopedic surgery and sports medicine has increased greatly, and the addition of platelet-rich plasma (PRP) to the surgical armamentarium is of particular note. Unfortunately, the number of PRP preparation devices has also grown immensely over the recent decades, raising meaningful concern for the considerable variation in the qualities of currently available PRP preparations. The lack of consensus on the standardization of PRP preparation and of agreement on condition specific PRP formulations is largely responsible for the sometimes contradictory outcomes in the literature. Furthermore, the full potential of PRP technology, the concept of individualized treatment protocols based on bioformulation options, and platelet dosing, angiogenesis, and antimicrobial and painkilling effects of PRP relevant to orthopedic surgery have rarely been addressed. In this review, we will discuss recent developments regarding PRP preparations and potential therapeutic effects. Additionally, we present a synopsis of several published data regarding PRP applications in orthopedic surgery for treating tendon injuries, inducing bone repair, strengthening spinal fusion outcomes, and supporting major joint replacements.
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Affiliation(s)
- Peter A Everts
- Science and Research Department, Gulf Coast Biologics, Fort Myers, FL, USA
| | | | | | - Dan S Cohen
- Spine Care Institute of Miami Beach, Mt. Sinai Medical Center, Miami Beach, FL, USA
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