This Level I double-blind RCT tested whether intraoperative autologous PRP improves outcomes after arthroscopic rotator cuff repair. 53 patients were randomized to PRP augmentation or standard repair, then followed with validated scores and MRI for 2 years. The question: does adding concentrated growth factors at the repair site improve pain, function, and tendon healing?
The clinical decision rule from this paper: do not expect PRP to rescue a large or retracted cuff tear, and do not counsel patients that it improves 2-year outcomes. What PRP reliably delivers is early pain reduction and faster 3-month functional recovery. That is relevant for the athlete or laborer who needs a quicker return, but the benefit disappears by 6 months as controls catch up.
The key mental model is tear retraction grade. Randelli's intraoperative grading (grade 1 edge over the tuberosity through grade 4 medial to the glenoid) predicts healing. Grade 4 tears re-tore 100% of the time regardless of PRP.
The subgroup signal, that grade 1-2 tears may hold sustained benefit, is hypothesis-generating and underpowered (only 35 patients). Treat it as a lead for future trials, not settled practice. Appraisal caveat: this is a small single-surgeon RCT with industry funding from the PRP manufacturer, and platelet/growth factor concentrations were never quantified.
This Level I double-blind RCT tested whether intraoperative autologous PRP improves outcomes after arthroscopic rotator cuff repair. 53 patients were randomized to PRP augmentation or standard repair, then followed with validated scores and MRI for 2 years. The question: does adding concentrated growth factors at the repair site improve pain, function, and tendon healing?
The clinical decision rule from this paper: do not expect PRP to rescue a large or retracted cuff tear, and do not counsel patients that it improves 2-year outcomes. What PRP reliably delivers is early pain reduction and faster 3-month functional recovery. That is relevant for the athlete or laborer who needs a quicker return, but the benefit disappears by 6 months as controls catch up.
The key mental model is tear retraction grade. Randelli's intraoperative grading (grade 1 edge over the tuberosity through grade 4 medial to the glenoid) predicts healing. Grade 4 tears re-tore 100% of the time regardless of PRP.
The subgroup signal, that grade 1-2 tears may hold sustained benefit, is hypothesis-generating and underpowered (only 35 patients). Treat it as a lead for future trials, not settled practice. Appraisal caveat: this is a small single-surgeon RCT with industry funding from the PRP manufacturer, and platelet/growth factor concentrations were never quantified.