Injection of Leukocyte-Poor Platelet-Rich Plasma During Rotator Cuff Repair Can Increase Healing Rate but Does Not Affect Clinical Outcomes: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Abstract

To evaluate the efficacy of injected leukocyte-poor platelet-rich plasma (LP-PRP) during arthroscopic rotator cuff repair, primarily in reducing failure rates and, secondarily, in improving shoulder function and clinical outcome. A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Medline/PubMed, Scopus, Web of Science, and Cochrane databases were searched up to August 31, 2025, for comparative studies investigating the injectable LP-PRP during arthroscopic rotator cuff repair. Inclusion criteria were Level I or II studies reporting clinical and radiological outcomes with more than 6-month follow-up. Data were extracted on failure incidence and patient-reported outcome measures. Quantitative synthesis was performed using inverse variance weighting, and heterogeneity was assessed with the I² statistic. Five randomized controlled trials (n = 470 patients; 235 LP-PRP, 235 control) were included. No difference was found in mean age (P = .760) and gender distribution (P = >.99) between the 2 study groups. Repair failure occurred in 34/213 (15.9%) in the LP-PRP group versus 63/217 (29.0%) in controls (odds ratio 2.16; 95% confidence interval 1.34-3.48; P = .001; relative risk 0.55; 95% confidence interval 0.38-0.79). The LP-PRP group showed greater improvements in Constant score at 6 months (31.6 vs 28.4; P = .001), 12 months (46.9 vs 44.2; P = .001), and 24 months (45.7 vs 42.8; P = .003), Single Assessment Numeric Evaluation at 12 months (42 vs 38.7; P = .036), University of California-Los Angeles at 6, 12, and 24 months (P < .001 for all), and visual analog scale at 3 months (5.9 vs 4.6; P = .001) and 24 months (5.2 vs 4.9; P = .012); nevertheless, none of these improvements reached the minimal clinically important difference. Complication rates were comparable between groups (9.4% vs 7.7%; P = .508). Injection of LP-PRP during rotator cuff repair appears to be a safe procedure that may increase the healing rate. However, it has not been associated with improvements in patient-reported outcome measures sufficient to reach the minimal clinically important difference. Level II, systematic review of Level I and II randomized controlled trials.