Platelet-Rich Plasma and Bone Marrow Stimulation in Double-Row Rotator Cuff Repair Does Not Improve Clinical Outcomes but Reduces Retear Rates: A Retrospective Analysis With Propensity Score Matching.

PURPOSE: To compare clinical and radiologic outcomes among patients undergoing double-row suture bridge (DRSB) repair alone, DRSB with platelet-rich plasma (PRP) augmentation, and DRSB with bone marrow stimulation (BMS) augmentation.

METHODS

This retrospective study was conducted between March 2019 and February 2023. Inclusion criteria included patients with medium-to-large-sized posterosuperior rotator cuff tears undergoing arthroscopic DRSB repair, with minimum of 2-years of postoperative follow-up and postoperative magnetic resonance imaging. After applying exclusion criteria, 1:1:1 propensity score matching was performed based on age, tear size, fatty infiltration, and smoking status. Clinical outcomes were assessed using the visual analog scale, the American Shoulder and Elbow Surgeons score, subjective shoulder value, the University of California at Los Angeles score, and range of motion (ROM). Structural integrity was evaluated by 6-month postoperative magnetic resonance imaging. Multivariate logistic regression was used to identify independent predictors of retears.

RESULTS

Of 396 patients included, 46 per group (DRSB alone, DRSB with PRP, and DRSB with BMS) were selected for comparison, matched by age, tear size, fatty infiltration, and smoking status. Clinical outcomes were assessed at mean follow-up of 24.2 ± 1.0 months (range, 22-27 months) and structural integrity at mean of 6.1 ± 0.3 months (range, 5-7 months) postoperatively. At 2-year follow-up, there were no significant differences among the 3 groups in clinical scores or ROM. However, the retear rate was significantly lower in DRSB with PRP group (10.9%) compared with both conventional DRSB group (30.4%) and DRSB with BMS (32.6%) group (P < .05) (DRSB vs PRP, P = .038; BMS vs. PRP, P = .021). Multivariate analysis identified PRP augmentation as an independent protective factor against retear (OR = 0.177, P = .024), whereas BMS did not confer significant benefit.

CONCLUSIONS

Using an identical double-row containment technique, retear rates were lower with PRP augmentation than with conventional repair or BMS augmentation. Two-year clinical scores and ROM were similar across groups, and BMS augmentation did not reduce retears compared with conventional repair.

LEVEL OF EVIDENCE: Level III, retrospective comparative study.