Meta-Analysis
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Jun 28, 2022; 10(3): 143-161
Published online Jun 28, 2022. doi: 10.13105/wjma.v10.i3.143
Evidence analysis on the utilization of platelet-rich plasma as an adjuvant in the repair of rotator cuff tears
Sathish Muthu, Naveen Jeyaraman, Keval Patel, Girinivasan Chellamuthu, Vibhu Krishnan Viswanathan, Madhan Jeyaraman, Manish Khanna
Sathish Muthu, Department of Orthopaedics, Government Medical College and Hospital, Dindigul 624001, Tamil Nadu, India
Sathish Muthu, Madhan Jeyaraman, Department of Biotechnology, School of Engineering and Technology, Sharda University, Greater Noida 201306, Uttar Pradesh, India
Sathish Muthu, Naveen Jeyaraman, Keval Patel, Girinivasan Chellamuthu, Madhan Jeyaraman, Manish Khanna, Research Associate, Indian Stem Cell Study GroupAssociation, Lucknow 226010, Uttar Pradesh, India
Sathish Muthu, Naveen Jeyaraman, Girinivasan Chellamuthu, Madhan Jeyaraman, Manish Khanna, Research Associate, Orthopaedic Research Group, Coimbatore 641001, Tamil Nadu, India
Naveen Jeyaraman, Keval Patel, Fellow in Orthopaedic Rheumatology, Dr Ram Manohar Lohiya National Law University, Lucknow 226010, Uttar Pradesh, India
Naveen Jeyaraman, Fellow in Joint Replacement, Atlas Hospitals (The Tamil Nadu Dr MGR Medical University), Tiruchirappalli 620002, Tamil Nadu, India
Girinivasan Chellamuthu, Fellow in Arthroscopy, Ortho-One Orthopaedic Speciality Centre (The Tamil Nadu Dr MGR Medical University), Coimbatore 641005, Tamil Nadu, India
Vibhu Krishnan Viswanathan, Department of Orthopaedics and Spine Surgery, Ganga Medical Centre and Hospitals, Coimbatore 641043, Tamil Nadu, India
Madhan Jeyaraman, Department of Orthopaedics, Faculty of Medicine, Sri Lalithambigai Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai 600095, Tamil Nadu, India
Madhan Jeyaraman, South Texas Orthopaedic Research Institute, Laredo, TX 78045, United States
Manish Khanna, Department of Orthopaedics, Autonomous State Medical College, Ayodhya 224135, Uttar Pradesh, India
Author contributions: Muthu S conducted the research along with Viswanathan VK, Jeyaraman N, Patel K, Chellamuthu G, Jeyaraman M and Khanna M helped in the conduction of the study; All authors have read and approved the final manuscript.
Conflict-of-interest statement: None of the authors have a conflict of interest over the subject presented.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Madhan Jeyaraman, Assistant Professor, Department of Orthopaedics, Faculty of Medicine, Sri Lalithambigai Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai 600095, Tamil Nadu, India. madhanjeyaraman@gmail.com
Received: December 18, 2021
Peer-review started: December 18, 2021
First decision: March 13, 2022
Revised: March 23, 2022
Accepted: June 21, 2022
Article in press: June 21, 2022
Published online: June 28, 2022
Processing time: 199 Days and 8.5 Hours
ARTICLE HIGHLIGHTS
Research background

Platelet-rich plasma has been gaining popularity as an agent for biological augmentation either as the sole treatment modality or as an adjunct to surgical repair.

Research motivation

There is growing evidence on the positive effects of platelet-derived autologous growth factors on collagen production, cell proliferation, tissue revascularization and tendon regeneration thereby making them useful as an augment to arthroscopic rotator cuff repair.

Research objectives

The overall purpose of the current study was to perform a detailed systematic review of the existing meta-analyses evaluating the role of PRP in patients undergoing rotator cuff repair; and to specifically provide answers to the following research questions, namely: (1) To evaluate the effect of this strategy on overall clinical outcome scores; (2) To evaluate the reduction in re-tear or failure rates; (3) To analyze the evolution and variations in the techniques of procurement and application of PRP across different studies; (4) To critically analyze and interpret the best currently available evidence and provide recommendations; and (5) To discern the major gaps in the existing literature and identify the scope for future research on this subject.

Research methods

We then utilized the Jadad decision algorithm to identify the study with the highest quality to represent the current best evidence to generate the recommendation.

Research results

Recent meta-analyses are more supportive of the role of intra-operative administration of PRPs at the bone-tendon interface in improving the overall healing and re-tear rates, functional outcome and pain. The initial size of the tear and type of repair performed do not seem to affect the benefit of PRPs. Among the different preparations used, leucocyte poor (LP)-PRP possibly offers the greatest benefit as a biological augment in these situations.

Research conclusions

Based on this systematic overview, we give a Level II recommendation that intra-operative use of PRPs at the bone-tendon interface can augment the healing rate, reduce re-tears, enhance functional outcome and mitigate pain in patients undergoing arthroscopic rotator cuff repair.

Research perspectives

LP-PRP possibly offers the greatest benefit in terms of healing rates as compared with other platelet preparations.