Clinical and Structural Outcomes After Arthroscopic Repair of Full-Thickness Rotator Cuff Tears With and Without Platelet-Rich Product Supplementation: A Meta-analysis and Meta-regression

Authors:

Ryan J Warth, Grant J Dornan, Evan W James, Marilee P Horan, Peter J Millett

Abstract:

Over the past decade, research has focused on enhancing the biomechanical properties of various rotator cuff repair constructs in an effort to improve the potential for tendon-footprint healing. Despite these improvements, retear rates have been persistently high regardless of the repair technique. Given the high rate of structural failure at the tendon- bone interface, successful rotator cuff repair is more likely to be reliant on the biological characteristics of healed tissues rather than the biomechanical strength of the repair construct.

After rotator cuff repair, it has been shown that the fibrovascular scar tissue deposited at the tendon- bone interface is inferior in quality to that of the native enthesis. This factor may partially explain the high rate of observed retears at the tendon-bone interface after rotator cuff repair and the subsequent decline in clinical outcomes. As a result, recent research has focused on the development of biological materials designed to enhance the strength and quality of repaired tissue at the tendon footprint.

Although many investigators have identified and studied the various biochemical signaling cascades involved in rotator cuff healing, an important study by Rodeo showed that isolated osteoinductive growth factors, specifically recombinant human bone morphogenic protein, could be used to improve the tissue quality at the site of rotator cuff repair in sheep. Others have shown that fibroblastic growth factor 2 may accelerate the remodeling process while also helping with the formation of granulation tissue. Because many other growth factors are also released from the alpha granules of activated platelets in physiological concentrations, it is theorized that the application of a biological material rich in platelets may help stimulate the development of normal-appearing histologic tissue characteristics at the repair site, decrease retear rates, and improve clinical outcomes after rotator cuff repair.

Several prospective comparative studies have examined the clinical or structural outcomes after the integration of various platelet-rich products (PRPs) with rotator cuff repairs; however, the results have been conflicting to date. As a result, controversy exists regarding the clinical efficacy of PRP supplementation during arthroscopic rotator cuff repair. Therefore, the purpose of this study was to perform a systematic re- view, meta-analysis, and meta-regression of all the Level I and Level II studies comparing the clinical or structural outcomes, or both, after rotator cuff repair with and without PRP supplementation. We hypothesized that there would be no statistically significant differences in clinical or structural outcomes between treatment groups.

For the complete study: Clinical and Structural Outcomes After Arthroscopic Repair of Full-Thickness Rotator Cuff Tears With and Without Platelet-Rich Product Supplementation: A Meta-analysis and Meta-regression

Peter Millett, MD

Average rating:

39 reviews

Alexandra Thompson

Mar 23, 2024

by Alexandra Thompson on Peter Millett, MD

110%

Dr. Millett and his team did a SLAP tear repair and bicep tenodesis on my left shoulder. I use my arms as an artist, and love to swim in the ocean, surf, paddle, and telemark ski. So regaining full use of my shoulder and keeping my bicep attached was very important to me. Now, over two years later, my shoulder has the equivalent range of motion as my other arm and as before the injury, and no pain. After the first three months it felt so good and was so strong that - to my horror - I completely forgot my six-month follow-up.

Not only did Dr. Millett and his team make my arm as good as new, but having had the experience of such kindness and expertise throughout the process of surgery and recovery is like an added shoulder superpower.

Thank you Rita, Brooke, Jason, Sarah, Camille, Olivia, Dr. Millett and everyone! And see you soon when my husband comes in for his knee...

Jeff Chandler

Jan 31, 2022

by Jeff Chandler on Peter Millett, MD

Flawless procedure, Easy recovery

Dr. Millet's repaired my knee and tibia, following a botched operation by a different surgeon. That procedure was virtually pain free and I was weight bearing within a few days. That was 18 years ago and the knee is still strong. A few years after the knee incident, Dr Millet repaired my shoulder. My insurance company approved me for 3 months of disability following that surgery. I was off pain medication in 2 days and had 90% range of motion within a week. I withdrew my disability claim and returned to work within two weeks of surgery. I’m not a famous athlete—just a regular guy. Nonetheless, I was treated like an NFL at the Steadman clinic. Most notable was the time for recovery. Other surgeons perform their hour-long task in the OR and don’t involve themselves in the other functions. Peter and his team manages the entire process from diagnosis, anesthesia, nursing care, and therapy. He takes a holistic approach to patient care and doesn’t skip any steps.

Jenn West

Jul 2, 2021

by Jenn West on Peter Millett, MD

Saved My Life

I went to Dr. Millett after 7 knee surgeries (6 on my right and 1 on my left) and had seen 11 different surgeons who all refused to remove femur metal from my right leg. I am highly allergic to metal and the chronic pain was leaving me bedridden for 3.5wks out of a month. He personally wrote me back on my inquiry, listened to my concerns, scheduled my surgery within a week (due to insurance issues) and personally followed up with my recovery. The level of patient care from Dr. Millett and his ENTIRE team is above any care I have ever received in my 20 years of dealing with orthopedic surgeons. There are not enough words to describe the level of care, dedication and professionalism you receive from Dr. Millett and his staff.
My only disappointment is that I did not find him sooner!!!

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Clinical and Structural Outcomes After Arthroscopic Repair of Full-Thickness Rotator Cuff Tears With and Without Platelet-Rich Product Supplementation: A Meta-analysis and Meta-regression

Authors:

Abstract:

About the Author: Peter Millett, MD