This meta-analysis pooled 17 randomized trials (1,104 patients) testing whether platelet-rich product augmentation improves rotator cuff repair. It compared all four PRP formulations (P-PRP, L-PRP, P-PRF, L-PRF) against controls for retear rates and clinical scores. The goal was to determine which formulation, if any, actually helps.
When a resident hears "PRP for rotator cuff," the reflexive answer is that the evidence is mixed. This meta-analysis sharpens that: the answer depends entirely on which formulation you mean.
Pure platelet-rich plasma (P-PRP), which is leukocyte-poor and liquid, was the only formulation that consistently reduced retears (OR 0.26) and improved Constant scores. The solid fibrin products (P-PRF, L-PRF) did not help, and the authors propose a mechanical reason: the sutured-in fibrin may create a tendon-bone gap as it dissolves.
Weigh the benefit carefully. The absolute retear reduction was about 6% (25.4% to 19.3%), and the clinical score gains, while significant, were small and may not cross the threshold of clinical importance.
Be critical of the evidence: 70% of included trials had high performance-bias risk, tear sizes could not be stratified, and surgical technique was not standardized. This is a real but modest effect, best framed as leukocyte-poor liquid PRP being the formulation with the most support.
This meta-analysis pooled 17 randomized trials (1,104 patients) testing whether platelet-rich product augmentation improves rotator cuff repair. It compared all four PRP formulations (P-PRP, L-PRP, P-PRF, L-PRF) against controls for retear rates and clinical scores. The goal was to determine which formulation, if any, actually helps.
When a resident hears "PRP for rotator cuff," the reflexive answer is that the evidence is mixed. This meta-analysis sharpens that: the answer depends entirely on which formulation you mean.
Pure platelet-rich plasma (P-PRP), which is leukocyte-poor and liquid, was the only formulation that consistently reduced retears (OR 0.26) and improved Constant scores. The solid fibrin products (P-PRF, L-PRF) did not help, and the authors propose a mechanical reason: the sutured-in fibrin may create a tendon-bone gap as it dissolves.
Weigh the benefit carefully. The absolute retear reduction was about 6% (25.4% to 19.3%), and the clinical score gains, while significant, were small and may not cross the threshold of clinical importance.
Be critical of the evidence: 70% of included trials had high performance-bias risk, tear sizes could not be stratified, and surgical technique was not standardized. This is a real but modest effect, best framed as leukocyte-poor liquid PRP being the formulation with the most support.