BIOLOGICAL AUGMENTATION WITH PLATELET DERIVED PRODUCTS

Several high strength studies confirm that the addition of liquid platelet-rich plasma or platelet-rich fibrin does not significantly change patient-reported outcomes.

Ten high- and seven moderate-quality studies (Antuna, 2013; Castricini, 2011; Malavolta, 2014; Malavolta, 2018; Pandey, 2016; Randelli, 2011; Randelli, 2022 (b); Rossi, 2024; Snow, 2020; Zumstein, 2016; Jo, 2015; Sanchez-Villacanas, 2021; Walsh, 2018; Wang, 2015; Zhang, 2016; Zhang, 2022; Zhang, 2023) investigated the effect of liquid platelet rich plasma (PRP) on post-operative full-thicknessfull-thickness re-tear rates. In pooled analysis, when stratifying by partial-thickness and full-thickness retear, neither grouping demonstrated lower relative risk of retear with PRP vs no PRP (RR = 1.5 (0.27-8.30) and RR 0.74 (0.48, 1.15) respectively, however, when tear type wasn’t stratified, the RR was 0.43 (0.28, 0.66) in favor of the PRP group.

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.