Perioperative Leukocyte-Poor Platelet-Rich Plasma Associated With Reduced Risk of Retear After Arthroscopic Rotator Cuff Repairs: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Abstract

To perform a systematic review and meta-analysis of randomized controlled trials in the literature to ascertain the clinical efficacy of leukocyte-poor platelet-rich plasma (LP-PRP) in arthroscopic rotator cuff repair. A through literature search was performed from databases such as PubMed, SCOPUS, Embase, Cochrane Library, and Google Scholar using key words. Eligible studies were randomized controlled trials with Level I or II evidence, an ≥80% follow-up rate, at least 12 months of follow-up, use of LP-PRP in arthroscopic rotator cuff repair, and report of postoperative outcomes. Our literature search yielded 9 randomized controlled trials consisting of 743 patients, with 380 patients receiving LP-PRP and 363 patients receiving a control or placebo. Postoperative outcomes analyzed were rotator cuff retear rates, visual analog scale (VAS) pain scores, American Shoulder and Elbow Surgeons (ASES) scores, University of California Los Angeles (UCLA) scores, and Constant scores. Retear rates were significantly lower in the LP-PRP treated group compared with controls (risk ratio 0.54; confidence interval [CI] 0.41-0.71; P < .00001), VAS pain scores were significantly lower in the LP-PRP treated group compared with controls (mean difference [MD] -0.12; CI -0.24 to -0.01; P < .04), ASES scores were significantly greater in the LP-PRP-treated group compared with controls (MD 1.88; CI 0.46-3.31; P < .01), Constant scores were significantly greater in the LP-PRP-treated group compared with controls (MD 2.58; CI 1.28-3.89; P < .0001), and UCLA scores were significantly greater in the LP-PRP-treated group compared with controls (MD 1.16; CI 0.17-2.16; P < .02). Retear rates showed a relative risk reduction of about 46% in patients who received LP-PRP compared with controls, and although VAS Pain Scores, ASES Scores, Constant Scores, and UCLA Scores all were significantly improved, these clinical outcomes scores did not meet the minimal clinical important difference established within the literature. Administration of LP-PRP is associated with significantly reduced postoperative retear rates at minimum 12 months follow-up compared with a saline injection control group. However, its use did not show clinically meaningful effects on postoperative pain or patient-reported outcomes, highlighting its primary benefit as enhancing structural healing. Level II, systematic review and meta-analysis of Level I and II studies.