Impact of Autologous Platelet Rich Plasma on Healing of Rotator Cuff Repairs
Condition: Rotator Cuff Pathology
Study type: Interventional
Phase: Phase 2

Summary: 
      Partial-thickness and full-thickness rotator cuff tears are common soft-tissue conditions
      that often require surgical treatment. Initial efforts to improve tendon healing centered on
      improving the strength of the repair construct. More recent studies have focused on biologic
      enhancement of the healing process. The use of platelet concentrates to improve healing, has
      been explored considerably during the last decade. Platelet Rich Plasma (PRP) is a fraction
      of plasma that has been isolated and used to enhance regeneration in bone and soft tissues.

      There is information on use of PRP in oral surgery, achilles tendon healing, limb lengthening
      procedures, chronic elbow tendinosis, ruptures/degenerative changes in the patellar tendon,
      and osteoarthritis of the knee. There are no randomized clinical trials to our knowledge that
      have examined the impact of PRP in patients with rotator cuff tear.

      The objective of the proposed pilot study is to examine the effectiveness of autologous
      Platelet Rich Plasma (PRP) application in promoting healing of the rotator cuff (RC) tendons
      following arthroscopic rotator cuff repair through a randomized controlled study.
    

Detailed description: 
      Surgical procedures: Arthroscopic inspection of the shoulder will be performed to assess
      intra-articular structures and to evaluate the rotator cuff and other sub-acromial
      structures.

      Arthroscopic Rotator Cuff Repair: Rotator cuff tears will be categorized as partial-thickness
      and full-thickness tears. The full-thickness tears will be classified as small (<1 cm),
      moderate (1-3 cm), and large (>3-5 cm) based on the largest dimension and will be treated
      with a repair using sutures and suture anchors as indicated.

      Rehabilitation: A comprehensive protocol with instructions on different types of exercises
      will be provided pre-operatively. Rehabilitation will be based on the standard protocols for
      these procedures used at the Holland Centre.

      Follow-ups: Patients will be monitored for 6 months, or when participation is terminated by
      the investigators, or because the patient withdrew consent or fails to return for visits. To
      evaluate safety, clinical laboratory (WBC, Hb, platelet count, serum chemistry and IL-6, CRP,
      PT, PTT and INR tests will be conducted at 6 weeks, and 3 months to determine the impact of
      treatment interventions.
    

Intervention name(s): Platelet Rich Plasma
Intervention type(s): Other
Intervention description(s): Patient's blood will be drawn prior to the start of the procedure. The processing disposable (PD) size of 60ml will be used to yield 7 ml of Platelet concentrate volume. Using the lateral portal, the applicator for the PRP will be positioned in between the bone and the repaired rotator cuff without a cannula. The inflow will then be closed and the arthroscopic fluid will be aspirated via the outflow cannula. All other cannulae will be removed, producing a dry subacromial space. The PRP and autologous thrombin will then be transferred to the sterile field and drawn up into a dedicated spray applicator kit (Smartjet) and applied to the site of repair. A dry arthroscopic check will be performed to evaluate the clot formation of the applied solution.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Intevention involved PRP injection
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Rotator Cuff Decompression Repair