Arthroscopic Knotless Tape Bridging with Platelet-Rich Fibrin Gel augmention: Functional and Structural Results

Background: Rotator cuff repairs remain a source of iterative ruptures and disappointing functional results. In this goal, platelet-rich plasma (PRP) have been used to improve tendon healing. This prospective study assessed the contribution of fully autologous gel concentrates (platelet concentrates and thrombin) on healing after cuff repair.

Methods: A consecutive series of 69 patients who underwent primary arthroscopic knotless tape bridging primary cuff repair of supraspinatus tear were evaluated. Two groups were created (A: n=32, B: n=37). PRP gel, obtained preoperatively by PRP mixed with autologous thrombin extracted from platelet-poor plasma, was injected at bone-tendon interface at end of repair in group A. Gel structure avoided evacuation of concentrates with irrigation liquid. Constant, QuickDash and Visual Analogue Scale (VAS) scores were assessed pre-operatively and then successively post-operatively. Healing was assessed by 24-month control MRI according to Sugaya`s classification. Scores of Sugaya 3, 4 and 5 were considered as iterative breaks.

Results: Average age was 56years (+/-7.8). Mean follow-up was similar: 28.6months (+/-3.3) vs 32.4months (+/-9.4). Mean preoperative Constant was similar: 53.4 (+/-3.4) vs 54.6 (+/-5.4). Group A patients received 3.5ml (+/-1.5ml) of PRP gel. No specific complications of injection were found. We observed higher trend in favor of PRP without signficativity: Constant 86.7 (+/-11.1) vs 81.6 (+/-14.4), p=0.11; VAS: 0.6 (+/-0.3) vs 1.1 (+/-0.9), p=0.13; Anteflexion: 139.5° (+/-14.4°) vs 137.7° (+/- 16.5°), p=0.63; Strength score: 17.6 vs 14.8, p=0.06; QuickDash: 6.2 (+/-5.3) vs 8.2 (+/-6.9), p=0.31. On MRI, 90% (n=3) of repairs were healed in group A versus 86% (n=5) in group B.

Conclusion: In this preliminary study, Group treated with PRP gel showed a trend towards better clinical and radiological results. These results were not significant at the last follow-up. Only significantly higher clinical results were found at 3 months.