Does platelet-rich fibrin aid cuff repair?

By: Mary Ann Porucznik

By Mary Ann Porucznik

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.”

The institutional review board (IRB)-approved study involved 60 patients, 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. 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 radiographs showed residual defects in both groups, the differences between the two groups were not significantl. No complications (infections, stiffness, or bleeding issues) occurred in either group.

“We found no significant difference in pain, narcotic use in the recovery room, discharge time, recovery of motion, or Simple Shoulder Test scores,” said

Dr. Weber. “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.

“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 the U.S. Food and Drug Administration has not required these products to prove their effectiveness, even though a wide range of products is available. He also noted 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 co-author 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.