Functional Outcomes in Patients Receiving Platelet-Rich Plasma (PRP) Injections Following Arthroscopic Repair for and Rotator Cuff Tears: A Review

Neil Gambhir OMS-III; Forrest Buttensky OMS-II; Hannah Fischer OMS-I; Olga Savinova PhD

Abstract Methods and Materials Results and Discussion

Meniscus and Rotator Cuff tears are two of the most common orthopaedic A PubMed search on the current literature involving PRP injections and All authors compared functional outcomes in a cohort of patients that underwent , and although conservative treatment is favored, these tears typically meniscal repairs was performed utilizing the key words PRP, arthroscopic, arthroscopic repair for meniscus or rotator cuff injuries to a group that received necessitate the utilization of arthroscopic surgery. and meniscus. This search included 8 papers from 2015-2020, and of those arthroscopic repair with concomitant PRP injections papers, the work of Kemmochi, Griffin, Dai, and Kaminski were included in Recovery times from these surgical procedures are lengthy and complications our review Regarding meniscus tears, none of the papers included displayed any significant different in functional outcomes when cohorts were compared to each other such as re-tears often arise. Platelet-rich plasma (PRP) injections in conjugation Author/Date Meniscal Tear PRP Group Control Group Clinical scale with arthroscopic surgery is a new approach to improve post-surgical functional (#, age, M/F) (#, age, M/F) utilized outcomes [1]. In this review, we will explore literature over the past 5 years and The papers involving Rotator Cuff tears yielded similar results. However, Holtby's summarize the conclusions regarding the efficacy of PRP injections measured as Masahiko Meniscal Tear 17, 32.4 ± 16.3, 5, 20.8 ± 8.8, IKDC, experiment revelated that patients that received PRP injections displayed a superior [13] functional outcomes following meniscus and rotator cuff arthroscopic surgeries. Kemmochi, 9/8 3/2 Lysholm, ROM at a 6 week evaluation vs the Non PRP group . 2018 [8] Tegner Seven meniscal and rotator cuff clinical studies were included, with significant Justin Griffin, Meniscal Tear 15, 26 ± 9, 20, 35 ± 14, IKDC differences found between control groups and PRP groups in the reported 2015 [9] 11/14 17/3 Lysholm outcomes in one study. While the utilization of PRP injections is increasing, further investigation must be conducted to fully uncover their therapeutic Wen-Li Dai, Discoid Lateral 14, 32.4, 6/8 15, 30.3, 5/10 Lysholm potential in conjunction with arthroscopic surgery 2019 [11] Rafal Complete 19, 30, 15/4 18, 26, 15/3 IKDC IKaminski, 2018 Vertical Introduction [12] Meniscus tear A PubMed search on the most recent literature involving PRP injections and Rotator Cuff tears was completed utilizing the key words PRP, Platelet Platelet Rich Plasma is obtained by centrifuging a patients own blood to first Rich Plasma, Arthroscopic, Rotator Cuff, Supraspinatus, Infraspinatus, separate the platelets from the RBCs, and then the platelet-rich plasma from the Teres minor and Subscapularis. This search consisted of 39 papers from Conclusions platelet-poor plasma [2]. The platelets are then injected back into the patient as a 2015-2020. Of those papers, the work of Holtby, Hak and Zhang were thick gel at the site where PRP is needed. Once reintroduced, the degranulated incorporated in this review While the utilization and popularity of PRP injections is increasing in the orthopaedic platelets release growth factors from their a-granules to augment the natural healing Author/Date Rotator Cuff PRP Group Control Group Clinical Scale world, further investigation must be conducted to fully uncover their true potential in process [3]. The newly injected PRP will contain a concentration of platelets up to Tear (#, age, M/F) (#, age, M/F) utilized conjunction with arthroscopic surgery. No significant difference was found between 1,000,000/uL, compared to the normal human platelet count of 150,000 to 350,000/uL control groups and experimental groups in clinical studies evaluating their utilization Richard Partial or Full 41, 59 ± 8, 41, 59 ± 8, ShortWORC, The use of PRP injections in orthopaedic injuries relies heavily on the use of in meniscal or treatment. However, some promise was seen in the platelets and their secretory products, which are paramount to tissue healing and Holtby, 2016 Thickness 20/21 21/20 ASES, CMS, initial phases of ROM recovery post-surgery. [13] repair. Some of these growth factors and adhesion molecules include TGF-β1, VEGF, Rotator Cuff ROM EGF, IGF-1 and fibronectin [4]. Thus, it is hypothesized that an abundance of platelets Tear and an influx of growth factors can facilitate the body’s own tissue repair and even accelerate this process [5] Alisha Hak, Rotator Cuff 12, 55 ± 6.3, 9/3 13, 55 ± 6.4, WORC, DASH After injection of PRP into the following arthroscopic repair, functionality can 2015 [14] Tear 10/3 References then be measured during and after the recovery process. The evaluation of post- surgical functional outcomes is measured via questionnaires that clinicians Zhenxiang Rotator Cuff 30, 56.9 ± 6.0, 30, 57.2 ± 7.4, CMS, DASH, . 1. Nourissat G, Mainard D, Kelberine F, French Arthroscopic Society (SFA) (2013) Current concept for the use of PRP in arthroscopic surgery. Orthop Traumatol Surg Res 99(8 Suppl):S407–S410 utilize during follow-up appointments. The International Knee Documentation [15] Zhang, 2016 Tear 15/15, 16/14 ROM 2. Alves R., Grimalt R. (2018). 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Measures of knee function: international knee documentation committee (IKDC) subjective knee evaluation form, knee and outcome score (KOOS), knee injury and osteoarthritis outcome score physical function short form (KOOS-PS), knee outcome survey activities of daily living scale Frequently used scales that evaluate function before and after surgery (KOS-ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale (ARS), and Tegner Activity Score (TAS) Care Res. 2011;63(Suppl 11):S208–S228. doi: 10.1002/acr.20632. consist of the Constant-Murley Score (CMS), American Shoulder and 7. Wylie, J. D., Beckmann, J. T., Granger, E., & Tashjian, R. Z. (2014). Functional outcomes assessment in shoulder surgery. World journal of orthopedics, 5(5), 623– Surgeons (ASES) Standardized Shoulder Form, Disabilities of the , Shoulder and 633. Contact 8. 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BMC Musculoskelet Disord. with concomitant PRP injections improved functional outcomes in patients with Neil Gambhir OMS-III 2019;20(1):113. 12. Kaminski R, Kulinski K, Kozar-Kaminska K, et al. A prospective, randomized, double-blind, parallel-group, placebo-controlled study evaluating meniscal healing, clinical meniscus and rotator cuff tears vs outcomes in aptients who only received New York Institute of Technology outcomes, and safety in patients undergoing meniscal repair of unstable, complete vertical meniscal tears (bucket handle) augmented with platelet-rich plasma. Biomed Res Int. arthroscopic repair 2018;2018:9315815. College of Osteopathic Medicine 13. Holtby, R., Christakis, M., Maman, E., MacDermid, J. C., Dwyer, T., Athwal, G. S., Faber, K., Theodoropoulos, J., Woodhouse, L. J., & Razmjou, H. (2016). Impact of Platelet- Rich Plasma on Arthroscopic Repair of Small- to Medium-Sized Rotator Cuff Tears: A Randomized Controlled Trial. 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