Platelet-rich fibrin matrix has no positive impact on rotator cuff repair

Comparison to a control group revealed relatively similar healing parameters, a study found.

Issue: April 2011

SAN DIEGO — The application of platelet-rich fibrin matrix to the tendon-bone interface at the time of rotator cuff repair has no significant impact upon tendon-healing vascularity, manual muscle strength, or clinical rating scales when compared to repair alone, according to a study presented here.

The findings were presented by Demetris Delos, MD, at the 2011 American Orthopaedic Society for Sports Medicine Specialty Day Meeting.

“Recently PRP [platelet-rich plasma] has been advocated as a new treatment to enhance the biological environment,” Delos said, citing a number of growth factors reportedly inherent in PRP. “These growth factors have been implicated in cell-proliferation, matrix synthesis, angiogenesis, etc. In the 2000s, we saw several case series with positive results, but these series were limited by the fact that there were no control groups or they were retrospective.

“We elected to use a platelet-rich fibrin matrix,” he added. “It is a little bit different from some of the other PRP compounds and commercial systems.”

Platelet-rich fibrin matrix is an autologous fibrin matrix formed by activation of the fibrin clotting cascade with the addition of calcium chloride and a second centrifugation step. The process reportedly minimizes platelet activation and traps inactivated platelets in the fibrin matrix, which allows for sustained cytokine release.

“The critical question we still had to answer was: Could platelet-rich fibrin matrix improve rotator cuff tendon healing rates?” Delos said.

Study methods and findings

Delos and his team performed a prospective, randomized trial of 67 patients undergoing arthroscopic rotator cuff repair. Patients were randomized to either receive platelet-rich fibrin matrix or no implant during their repair, with 36 patients receiving the implant and 31 undergoing the repair alone. Patients and evaluators were blinded to treatment groups, and follow-up was a minimum of 1 year.

Attachment of the platelet-rich fibrin matrix to the suture occurred at the interface of the tendon and the greater tuberosity. Standard repair techniques were utilized, Delos reported, and postoperative rehabilitation procedures were the same for both groups. Primary outcome was tendon healing, which was evaluated by ultrasound at the 6- and 12-week marks. Secondary outcomes included ASES (Association of Shoulder and Elbow Surgeons) and the L’Insalata Shoulder Questionnaire evaluations, as well as strength testing. To predict outcomes based on tear severity, repair type, treatment type and platelet count, the group utilized a logistic regression model.

Delos reported no differences between the two groups with regards to tendon-to-bone healing. Twenty-four of the 36 patients (67%) in the platelet-rich fibrin matrix group displayed intact repairs, compared to 25 of the 31 patients (81%) in the control group at 12 weeks postoperatively, based on ultrasound evaluation. In terms of ultrasound findings, there were no significant differences in healing between groups at the 6- and 12-week marks. Further, there were no differences in ASES scores, L’Insalata questionnaires, and strength scores between the groups.

The vascularity of the repaired tendons, Delos added, was similar between the two groups.

Preoperative platelet count was found to have no effect on healing, and Delos reported that logistic regression analysis demonstrated platelet-rich fibrin matrix was “a significant predictor” for tendon defect at the 12-week mark.

“No positive effect”

“When we take this as a whole, platelet-rich fibrin matrix as we applied it at the tendon-bone interface done at the time of arthroscopic rotator cuff repair had no positive effect on tendon defect rate, tendon vascularity … muscle strength, and clinical rating scales,” Delos said.

Delos noted the results are potentially due in part to a relatively small cohort, as well as variability in platelet recovery, platelet activation and kinetics of cytokine release from the platelet-rich fibrin matrix.

Weaknesses inherent in the study – such as the absence of platelet-rich fibrin matrix platelet concentration and the relatively small cohort – mean further study is warranted to investigate the role of platelet-rich fibrin matrix in rotator cuff repair, he added. – by Robert Press

Reference:

Rodeo SA, et al. The effect of platelet-rich fibrin matrix on rotator cuff tendon healing: A prospective, randomized clinical study. Paper 9624. Presented at the 2011 American Orthopaedic Society for Sports Medicine Specialty Day. Feb. 19. San Diego.

Demetris Delos, MD, can be reached at 535 East 70th Street, New York, NY 10021; e-mail: delosd@hss.edu.

Disclosure: Delos has no relevant financial disclosures.