Effect of Platelet-Rich Plasma Dosing for Healing after Arthroscopic Cuff Repair Compared to Surgery Alone: A Systematic Review and Meta-Analysis

ABSTRACT Introduction Platelet-rich plasma (PRP) has been used for arthroscopic rotator cuff repairs (aRCR), but no studies have addressed the impact of platelet concentration. The primary aim was to evaluate whether the PRP cell concentration has an effect on tendon healing after aRCR compared to surgery alone. The secondary aim was to assess the functional and pain outcomes. Materials and Methods A systematic review was performed with searches in the MEDLINE (PubMed), Scopus, Web of Science and Cochrane (Central) databases according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Metanalytic procedures were performed for randomized controlled trials (RCTs), and a subgroup analysis was used for studies with target (approximately 10 6 cells/μL) or below-target PRP cellular concentrations (app. 5x10 5 cells/μL) regarding the primary outcome of tendon healing. Results This review included 10 studies (8 RCTs) with 342 patients in the aRCR+PRP group and 344 patients with isolated aRCR. The risk of bias was low to intermediate (6/4, respectively). Meta-analysis of the RCT revealed that the aRCR + high-concentration PRP group had an approximately 3.9-fold higher chance of healing than the non-PRP group (OR = 3.89, 95% CI = [1.78-8.44]; p = 0.0007). No significant difference in healing was found between the aRCR + low-concentration PRP and non-PRP groups (OR = 2.21, 95% CI = [0.66-7.45], p = 0.2). The CMS and UCLA scores were significantly improved in the aRCR+PRP groups with more than 12 months of follow-up, and no significant differences were found consistently for the ASES and VAS scores. Conclusions This study highlights that a PRP cell concentration close to the target (10 6 cells/μL) of patients with aRCR may improve their healing and functional outcomes and that dosing may be potentially useful in therapy.