Injection of leukocyte-poor platelet-rich plasma for moderate-to-large rotator cuff tears do not improve clinical outcomes but reduce retear rates and fatty infiltration: A prospective single-blinded randomized study.
Injection of leukocyte-poor platelet-rich plasma for moderate-to-large rotator cuff tears do not improve clinical outcomes but reduce retear rates and fatty infiltration: A prospective single-blinded randomized study.
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DOI：
10.1016/j.arthro.2022.02.007
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发表时间：
2022-03
期刊：
影响因子：
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通讯作者：
Chi Zhang;You-Zhi Cai;Yue Wang
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文献类型：
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作者：
Chi Zhang;You-Zhi Cai;Yue Wang
ObjectivesTo确定是否白细胞贫乏的富血小板血浆（LP-PRP）减少再撕裂率，减少脂肪浸润，并改善功能的结果与退行性中度至大型肩袖tears.MethodsThis患者是一个随机对照研究在一个单一的中心。入组了104例中度至重度肩袖撕裂患者的连续系列，并随机分配至对照组（仅双排缝合桥关节镜肩袖修复术，n = 52）和研究组（双排缝合桥修复术，随后在手术期间、术后第7天和第14天在肌腱修复部位注射3次Lp-PRP，n = 52）。随访24-36个月（27.2个月），分别采用加州大学洛杉矶分校（UCLA）肩关节功能评定量表、Constant评分和视觉模拟评分（VAS）进行评价。在术后24个月通过磁共振成像使用Sugaya分级和Goutallier分级评估修复组织的完整性和脂肪浸润。采用t检验、χ 2检验及Kendalltau-b相关系数进行统计学分析。最终，共有89名患者接受了24个月的随访。对照组的平均UCLA评分从14.80 ± 2.53增加到29.37 ± 2.06，研究组从13.74 ± 3.30增加到30.14 ± 2.32（P= 0.103）。对照组的平均Constant评分从46.56 ± 5.90增加到86.83 ± 4.94，研究组从44.37 ± 7.92增加到88.80 ± 4.92（P= 0.063）。对照组VAS评分从3.22 ± 1.24降至0.97 ± 1.12，研究组从3.49 ± 1.52降至1.16 ± 0.99（P= 0.41）。术前和术后UCLA评分、Constant评分和VAS的所有差异均达到了关节镜肩袖修复术的最小临床重要差异。在89名患者中，76名在术后24个月进行了磁共振成像。研究组再撕裂率为17.6%，低于对照组的38.1%，P = 0.049。此外，术后两组Goutallier分级差异有统计学意义（Kendall tau-b-0.24，P = .03），而术前两组Goutallier分级差异无统计学意义（Kendall tau-b-0.18，P = .11）。有没有并发症的patients.ConclusionsOur程序涉及重复注射LP-PRP在手术过程中，在第7和14天，如本研究中所述，有积极的影响，减少再撕裂率和促进Goutallier等级的患者关节镜下肩袖修复术，也可以提供大量的临床结果，达到最小的临床重要差异的手术治疗。然而，考虑到可供分析的数字，与对照组相比，它并没有促进更好的临床结果。证据等级II，随机对照研究。
ObjectivesTo determine whether leukocyte-poor platelet-rich plasma (Lp-PRP) reduced retear rates, reduced fatty infiltration, and improved functional outcomes in patients with degenerative moderate-to-large rotator cuff tears.MethodsThis was a randomized controlled study at a single center. A consecutive series of 104 patients with moderate-to-large rotator cuff tears was enrolled and randomly allocated to a control group (double-row suture-bridge arthroscopic rotator cuff repair alone, n = 52) and a study group (double-row suture-bridge repair followed by 3 Lp-PRP injections at the tendon repair site during surgery, at days 7 and 14 after surgery, n = 52). All patients were followed up for 27.2 months (range 24-36 months), with University of California at Los Angeles (UCLA) shoulder rating scale, the Constant score, and a visual analog scale (VAS) evaluated respectively. The integrity and fatty infiltration of repaired tissue were assessed by magnetic resonance imaging using the Sugaya classification and Goutallier grade classification at 24 months after surgery. Statistical analysis was performed based on thettest, χ2test, and the Kendall tau-b correlation coefficient.ResultsFour patients refused follow-up, and 11 patients had incomplete data. Eventually, a total of 89 patients were available for 24 months follow-up. The mean UCLA score increased from 14.80 ± 2.53 to 29.37 ± 2.06 in control group and from 13.74 ± 3.30 to 30.14 ± 2.32 in study group (P= .103). The mean Constant score increased from 46.56 ± 5.90 to 86.83 ± 4.94 in control group and from 44.37 ± 7.92 to 88.80 ± 4.92 in study group (P= .063). The VAS score decreased from 3.22 ± 1.24 to 0.97 ± 1.12 in control group and in 3.49 ± 1.52 to 1.16 ± 0.99 in study group (P= .41). All differences in UCLA score, Constant score, and VAS between pre- and postoperation achieved minimal clinically important differences proposed for arthroscopic rotator cuff repair. Of the 89 patients, 76 had magnetic resonance imaging performed at 24 months after surgery. The retear rate was 17.6% in study group, which was lower than that in control group (38.1%,P= .049). In addition, the Goutallier grade was found to be significant difference between groups postoperatively (Kendall tau-b –0.24,P= .03) but no significant difference preoperatively (Kendall tau-b –0.18,P= .11). There were no complications in the patients.ConclusionsOur procedures involving repeated injections of Lp-PRP during surgery and at days 7 and 14, as described in this study, have positive effects on reducing retear rate and promoting Goutallier grade in patients following arthroscopic rotator cuff repair and could also provide substantial clinical outcomes that reach the minimal clinically important difference for surgical treatment. However, given the numbers available for analysis, it did not promote better clinical results when compared with the control group.Level of EvidenceII, randomized controlled study.