Strong evidence does not support biological augmentation of rotator cuff repair with platelet-derived products on improving patient reported outcomes; however, limited evidence supports the use of liquid platelet rich plasma (PRP) in the context of decreasing re-tear rates.

Management of Rotator Cuff Injuries
Endorsed by: AANA, ASES, AOSSM, ASSET, APTA
Strong Evidence STRONG EVIDENCE
Rationale
Several high strength studies confirm that the addition of liquid platelet-rich plasma or platelet-rich fibrin does not significantly change patient-reported outcomes.

Seven high quality studies (Jo, C.H. 2015; Malavolta, E.A. 2014; Pandey, V. 2016; Randelli, P., 2011; Wang, A. 2015; Zhang, Z. 2016; Flury 2016)  that investigated the effect of liquid platelet rich plasma (PRP) on post-operative full thickness re-tear rates.  A pooled analysis of randomized trials demonstrated a lower relative risk of full thickness re-tear [RR=0.43 (95% CI 0.26 – 0.69)] when patients treated PRP were compared with controls.  While there was minimal statistical heterogeneity (I2=3.6%) in this analysis, there was a significant amount of clinical variability in the size of the tears, the type of PRP kit that was utilized, PRP application techniques, and fixation constructs.  Given that an uncontrolled analysis was conducted (i.e. not enough studies for a meta-regression), the results should be interpreted with caution.  With respect to platelet rich fibrin, there is insufficient evidence to make a recommendation for or against its utilization in reducing post-operative rotator cuff re-tear rates. Due to limited numbers in the pooled analysis, subgroup analyses for rotator cuff tear size could not be performed.

Risks and Harms of Implementing this Recommendation
There are no known harms associated with the use of PRP.

Future Research
Future studies should standardize the type of PRP formulation utilized or at the very least measure the concentrations of key constituents.  Furthermore, larger studies will allow for controlled statistical analyses that consider the effect of confounders such as fixation constructs, marrow venting, size of tears, etc. Consistency in the definition of rotator cuff re-tear is also encouraged.
  1. Flury, M., Rickenbacher, D., Schwyzer, H. K., Jung, C., Schneider, M. M., Stahnke, K., Goldhahn, J., Audige, L. Does Pure Platelet-Rich Plasma Affect Postoperative Clinical Outcomes After Arthroscopic Rotator Cuff Repair? A Randomized Controlled Trial. American Journal of Sports Medicine 2016; 8: 2136-46
  2. Jo, C. H., Shin, J. S., Shin, W. H., Lee, S. Y., Yoon, K. S., Shin, S. Platelet-rich plasma for arthroscopic repair of medium to large rotator cuff tears: a randomized controlled trial.[Erratum appears in Am J Sports Med. 2016 Jan;44(1):NP3; PMID: 26729728]. American Journal of Sports Medicine 2015; 9: 2102-10
  3. Malavolta, E. A., Gracitelli, M. E., Ferreira Neto, A. A., Assuncao, J. H., Bordalo-Rodrigues, M., de Camargo, O. P. Platelet-rich plasma in rotator cuff repair: a prospective randomized study. American Journal of Sports Medicine 2014; 10: 2446-54
  4. Pandey, V, Bandi, A, Madi, S, Agarwal, L, Acharya, Kk, Maddukuri, S, Sambhaji, C, Willems, Wj Does application of moderately concentrated platelet-rich plasma improve clinical and structural outcome after arthroscopic repair of medium-sized to large rotator cuff tear? A randomized controlled trial. Journal of Shoulder and Elbow Surgery 2016; 8: 1312-1322
  5. Randelli, P., Arrigoni, P., Ragone, V., Aliprandi, A., Cabitza, P. Platelet rich plasma in arthroscopic rotator cuff repair: a prospective RCT study, 2-year follow-up. Journal of Shoulder & Elbow Surgery 2011; 4: 518-28
  6. Zhang, Z., Wang, Y., Sun, J. The effect of platelet-rich plasma on arthroscopic double-row rotator cuff repair: a clinical study with 12-month follow-up. Acta Orthopaedica et Traumatologica Turcica 2016; 2: 191-7