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In vivo clinical and radiological effects of platelet-rich plasma on interstitial supraspinatus lesion: Case series - 01/12/16

Doi : 10.1016/j.otsr.2016.09.010 
A. Lädermann a, b, c, , M.A. Zumstein d , F.C. Kolo e , M. Grosclaude f , L. Koglin f , A.J.P. Schwitzguebel a
a Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Rue J.D. Maillard 3, 1217 Meyrin, Switzerland 
b Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1211 Geneva 4, Switzerland 
c Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, CH-1211 Geneva 14, Switzerland 
d Shoulder, Elbow & Orthopaedic Sports Medicine, Department of Orthopaedics and Traumatology University Hospital Bern, Inselspital, 3010 Bern, Switzerland 
e Department of Radiology, Geneva University Hospitals, Geneva, Switzerland 
f Division of sports medicine, La Tour Hospital, Rue J.D. Maillard 3, 1217 Meyrin, Switzerland 

Corresponding author at: Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Rue J.-D. Maillard 3, 1217 Meyrin, Switzerland. Tel.: +41 22 7197555; fax: +41 22 7196077.Division of Orthopaedics and Trauma Surgery, La Tour HospitalRue J.-D. Maillard 3Meyrin1217Switzerland

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Abstract

Background

Rotator cuff tear (RCT) is a frequent condition of clinical relevance that can be managed with a symptomatic conservative treatment, but surgery is often needed. Biological components like leukocytes and platelet rich plasma (L-PRP) could represent an alternative curative method for interstitial RCT.

Hypotheses

It has been hypothesized that an ultrasound guided L-PRP injection in supraspinatus interstitial RCT could induce radiological healing.

Material and methods

A prospective case series including 25 patients was performed in order to assess the effect of L-PRP infiltration into supraspinatus interstitial RCTs. Primary outcome was tear size change determined by magnetic resonance imaging arthrogram (MRA) before and 6 months after L-PRP infiltration. Secondary outcomes were Constant score, SANE score, and pain visual analog scale (VAS) after L-PRP infiltration.

Results

Tear volume diminution was statistically significant (P=.007), and a >50% tear volume diminution was observed in 15 patients. A statistically significant improvement of Constant score (P<.001), SANE score (P=.001), and VAS (P<.001) was observed. In 21 patients, Constant score improvement reached the minimal clinical important difference of 10.4 points.

Discussion

We observed a statistically significant and clinically relevant effect on RCT size and clinical parameters after L-PRP infiltration. Such an important improvement of supraspinatus interstitial RCT with conservative management is uncommon, therefore intratendinous L-PRP infiltrations could have been beneficial. This encouraging result could pave the way for future randomized studies in order to formally determinate whether L-PRP infiltrations are a possible alternative to surgical treatment of interstitial RCT.

Level of evidence

Prospective observational study; Level of evidence II.

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Abbreviations : RCT, L-PRP, MRA, VAS, NSAIDs, PRC, MCID

Keywords : Rotator cuff lesion, Supraspinatus, Leukocyte rich-platelet-rich plasma (L-PRP), Growth factor, Platelets


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Vol 102 - N° 8

P. 977-982 - décembre 2016 Regresar al número
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