It's an honor to be here today, also virtually, as a consequence of the COVID-19-related travel restrictions. Today, I'm presenting a study of 10 years of follow-up, analyzing the efficacy of platelet-rich plasma in rotator cuff repair. Many important studies have analyzed the results of rotator cuff repair, reporting good clinical outcomes after many years. On the other side, when performing an instrumental analysis, a new tendon lesion was found in many patients. In a study realized by the team aided by Professor Randelli, the tendon quality at final follow-up was found to be related to the initial tear, with worse findings in bigger lesions. However, this aspect was not related to minor constant score outcomes, also if lower abduction, flexion strength, and osteoarthritic progression was found. The authors concluded that an excellent surgical repair could help to obtain better clinical and functional outcomes, patient satisfaction, and reducing osteoarthritic progression. Based on this experience, the authors promoted a new study. The hypothesis was that the application of autologous PRP improves tendon healing after arthroscopic rotator cuff repair. This is a spontaneous, prospective, randomized, controlled, double-blind clinical trial. Researchers enrolled 53 patients, 26 patients in the PRP group and 27 in the control group. Surgical repair was performed using a single-row technique and 6 mL of PRP and autologous thrombin. The PRP injection was performed at the end of the surgical procedure. The patients were evaluated both clinically and radiologically. The clinical scores were the constant score, the UCLA-NRS scale, and simple shoulder test. The radiological evaluation included ultrasound and X-rays. Parts of the study reported that the mean age at the time of surgery was 62 years with homogenous groups, lesions affecting the abdominal limb in 77% of the patients, and more than 10 years of follow-up. These graphics demonstrate that clinical scores were similar in both groups, without statistical differences at 10 years of follow-up. Results regarding post-operative pain reported significant differences in pain reduction at 1 and 2 weeks after surgery, but no differences at 10 years. The initial reduction of pain could be related to the release of proteases-activated receptor 4, with many pain-modulatory properties in inflammations. As shown in this graphic, the authors found no significant differences regarding supraspinatus integrity between the group at final follow-up. These slides describe an interesting aspect. When groups were divided into patients with intact and non-intact tendons at the final follow-up, intact tendons reported much more strength than the others, both in abduction and external rotation. Still, these differences were not present in clinical evaluation. This study has many limitations. If we had a significant dropout of patients at final follow-up, 29%, and the population enrolled was old at the time of surgery, the ultrasound evaluation could be considered a limit, since it is highly operator-dependent. This study concludes that PRP does not improve long-term clinical and radiological results of arthroscopic rotator cuff repair. The only advantage is a slight reduction of early postoperative pain, which hardly justifies the routine use of PRP. The strength found in patients with intact tendons should promote the study of new techniques to permit better long-lasting tendon repair and reduce new tears. Thank you very much for your attention.

platelet-rich plasma

rotator cuff repair

tendon lesions

clinical outcomes

osteoarthritic progression