Published 3/1/2010

Arthroscopic cuff repair remains problematic

Addition of platelet-rich fibrin matrix doesn’t improve clinical results

In a prospective, randomized study, the addition of platelet-rich fibrin matrix (PRFM) during arthroscopic repair of the rotator cuff did not significantly improve perioperative morbidity or clinical results, according to a paper presented at the 2010 AAOS Annual Meeting.

“Early, anecdotal studies have suggested both improved healing rates and improvement in perioperative morbidity with PRFM,” said study author Stephen C. Weber, MD, “but within the power of this study, PRFM was not shown to significantly improve perioperative morbidity, and early follow-up did not show significant improvement in structural integrity.”

Sixty patients were randomized to arthroscopic treatment either with or without PRFM. Patients with prior surgery or open procedures were excluded, as were patients with clotting disorders or who were taking anticoagulants because they did not form a PRP clot. Postoperative rehabilitation was identical and patients were assessed at 1, 3, and 6 weeks and at 3 months postoperative.

Surgical time was significantly longer (p > 0.02) for patients receiving PRFM (97.5 min.) than for patients without PRFM (78.25 min.). No significant differences were found in pain, narcotic use, or discharge time. Although a preliminary review of postoperative magnetic resonance images showed residual defects in both groups, the differences between the two groups were not significant. No complications (infections, stiffness, or bleeding issues) occurred in either group.

“Final ASES and UCLA scores were not significantly different between groups. Structural results correlated with age and size of tear, consistent with prior published work,” said Dr. Weber.

“The reason for the failure of PRFM to fulfill its promise is unclear,” he continued. “Perhaps the biggest problem is the lack of data on how best to use platelet-rich plasma products clinically.”

Dr. Weber explained that questions of how, where, and how much to use have yet to be answered.

“The variability of the PRFM created by each individual patient may be a factor,” he said. “The biologic goals of resolving tendinopathy and improving the structural integrity of repairs are very different, and it may be unreasonable to expect one product to do both well.”

Dr. Weber’s coauthor for “Platelet-Rich Fibrin Matrix in the Management of Arthroscopic Repair of the Rotator Cuff: A Prospective, Randomized Study” is Jeffrey I. Kauffman, MD. Dr. Weber reports no conflicts of interest; Dr. Kauffman reports ties to Ferring Pharmaceuticals.