Platelet‐Rich Products Can Have Variable Effects on Outcomes After Arthroscopic Full‐Thickness Rotator Cuff Repair: A Meta‐analysis of Randomized Controlled Trials

PURPOSE: To determine the effects of different platelet-rich products on the clinical outcomes of patients undergoing arthroscopic full-thickness rotator cuff repair. METHODS: We searched the MEDLINE, EMBASE, and Cochrane databases for randomized controlled trials. Data included the retear rate and functional outcomes and subgroup analyses were performed to investigate the effect of 7 characterized platelet-rich products. Risks of bias of all trials were assessed using a Cochrane risk of bias tool, and data analysis was performed using RevMan 5.3 and Stata 15 software. RESULTS: Fifteen randomized controlled trials were included. Platelet-rich products resulted in significant improvements in retear rates and Constant scores, visual analog scale scores, and the University of California, Los Angeles scores (P < .05). However, there was no significant effect on the American Shoulder and Elbow Surgeons scores. Subgroups showed lower retear rates with platelet-rich products having either poor leukocytes (P < .0001) or higher platelet concentrations (P = .0005), liquid form (P = .0005), platelet-rich plasma type (P < .0001), and tendon-bone interface (P = .0006) or intratendinous application (P = .030) during surgery (P < .0001) compared with controls. Higher Constant scores occurred with platelet-rich products having either poor leukocytes (P = .004) or higher platelet concentrations (P = .05), liquid form (P = .01) or platelet-rich plasma type (P = .008), and single (P = .02) intratendinous (P = .04) application during surgery (P = .02). CONCLUSIONS: The use of platelet-rich products as augmentation in rotator cuff surgical repair significantly reduces the retear rate and improves the functional scores, though the clinical significance appears not to be meaningful. If used, we recommend platelet-rich products with poor leukocytes and high platelet concentrations, or liquid platelet-rich products in platelet-rich plasma type with a single intratendinous injection during surgery. LEVEL OF EVIDENCE: Level II, meta-analysis of Level I and II randomized controlled trials.