Platelet-rich Fibrin Matrix NOT helpful in Rotator Cuff Repair Surgery

Platelet-rich plasma comes in a variety of forms.  Platelet-rich fibrin matrix (PRFM) is prepared by spinning blood and adding calcium to create a type of gel that can hold suture.  In the study below, this gel was used in combination with a standard arthroscopic rotator cuff repair.  No differences were seen in healing as measured by ultrasound at 6 and 12 weeks when the PRFM was added.  There was also some suggestion that platelet rich fibrin matrix had a negative effect on healing.

It is crucial to understand that this data is specific to PRFM and not all types of platelet rich plasma.  Most patients and even many providers fail to realize the importance of formulation and indications.  PRP in the near future will become even more complex as newer formulations become available and as data matures.

AM
Total Tendon

The Effect of Platelet-Rich Fibrin Matrix on Rotator Cuff Tendon Healing: A Prospective, Randomized Clinical Study

1. Scott A. Rodeo, MD, 
2. Demetris Delos, MD,
3. Riley J. Williams, MD, 
4. Ronald S. Adler, MD, PhD, 
5. Andrew Pearle, MD and 
6. Russell F. Warren, MD

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1. Sports Medicine and Shoulder Service, The Hospital for Special Surgery, New York, New York
2. Sports Medicine and Shoulder Service, The Hospital for Special Surgery, New York, New York
3. Sports Medicine and Shoulder Service, The Hospital for Special Surgery, New York, New York
4. Sports Medicine and Shoulder Service, The Hospital for Special Surgery, New York, New York
5. Sports Medicine and Shoulder Service, The Hospital for Special Surgery, New York, New York
6. Sports Medicine and Shoulder Service, The Hospital for Special Surgery, New York, New York

Abstract

Background: There is a strong need for methods to improve the biological potential of rotator cuff tendon healing. Platelet-rich fibrin matrix (PRFM) allows delivery of autologous cytokines to healing tissue, and limited evidence suggests a positive effect of platelet-rich plasma on tendon biology.

Purpose: To evaluate the effect of platelet-rich fibrin matrix on rotator cuff tendon healing.

Study Design: Randomized controlled trial; Level of evidence, 2.

Methods: Seventy-nine patients undergoing arthroscopic rotator cuff tendon repair were randomized intraoperatively to either receive PRFM at the tendon-bone interface (n = 40) or standard repair with no PRFM (n = 39). Standardized repair techniques were used for all patients. The postoperative rehabilitation protocol was the same in both groups. The primary outcome was tendon healing evaluated by ultrasound (intact vs defect at repair site) at 6 and 12 weeks. Power Doppler ultrasound was also used to evaluate vascularity in the peribursal, peritendinous, and musculotendinous and insertion site areas of the tendon and bone anchor site. Secondary outcomes included standardized shoulder outcome scales (American Shoulder and Elbow Surgeons [ASES] and L’Insalata) and strength measurements using a handheld dynamometer. Patients and the evaluator were blinded to treatment group. All patients were evaluated at minimum 1-year follow-up. A logistic regression model was used to predict outcome (healed vs defect) based on tear severity, repair type, treatment type (PRFM or control), and platelet count.

Results: Overall, there were no differences in tendon-to-bone healing between the PRFM and control groups. Complete tendon-to-bone healing (intact repair) was found in 24 of 36 (67%) in the PRFM group and 25 of 31 (81%) in the control group (P = .20). There were no significant differences in healing by ultrasound between 6 and 12 weeks. There were gradual increases in ASES and L’Insalata scores over time in both groups, but there were no differences in scores between the groups. We also found no difference in vascularity in the peribursal, peritendinous, and musculotendinous areas of the tendon between groups. There were no differences in strength between groups. Platelet count had no effect on healing. Logistic regression analysis demonstrated that PRFM was a significant predictor (P = .037) for a tendon defect at 12 weeks, with an odds ratio of 5.8.

Conclusion: Platelet-rich fibrin matrix applied to the tendon-bone interface at the time of rotator cuff repair had no demonstrable effect on tendon healing, tendon vascularity, manual muscle strength, or clinical rating scales. In fact, the regression analysis suggests that PRFM may have a negative effect on healing. Further study is required to evaluate the role of PRFM in rotator cuff repair.