The effect of perioperative platelet-rich plasma injections on postoperative failure rates following rotator cuff repair: a systematic review with meta-analysis

Background: Platelet-rich plasma (PRP) has gained significant interest in recent years to potentially add biological augmentation of healing to surgical repairs of soft-tissue injuries. We sought to determine whether perioperative PRP injection influences the risk of failure following rotator cuff repair. Methods: A systematic search was performed in the Embase and PubMed databases and identified 16 randomized controlled trials or prospective cohort studies (1045 participants) reporting rates of failure, defined as a subsequent tear on postoperative imaging, after rotator cuff repair with or without perioperative PRP administration. A random-effects meta-analysis of the included studies was performed to determine the pooled effect of PRP administration on the postoperative failure risk. Results: Among the 16 studies investigating rotator cuff repairs, PRP augmentation resulted in a 25% reduction in the risk of repair failure, with low heterogeneity among the included studies. A significant protective effect was seen for studies of only small to medium tears (7 studies) (P = .007) and studies including large or massive tears (9 studies) (P < .001). Conclusions: Intraoperative PRP reduces the failure risk following rotator cuff repair and has a consistent effect regardless of tear size. However, because of the variability in PRP preparations, a specific recommendation cannot be made. (C) 2020 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.