Injection of Leukocyte-Poor Platelet-Rich Plasma During Rotator Cuff Repair Can Increase Healing Rate but Does Not Affect Clinical Outcomes: A Systematic Review and Meta-analysis of Randomized Controlled Trials
In brief
Leukocyte-poor PRP halves rotator cuff retear rate but not patient outcomes
In a meta-analysis of five randomized trials (470 shoulders), injecting leukocyte-poor platelet-rich plasma during arthroscopic repair reduced structural failure from 29% to about 16%, roughly a 45% relative risk reduction. Functional scores improved slightly but never reached clinically meaningful thresholds, and complication rates were similar. The technique appears safe and may boost healing, yet it does not translate into noticeable symptom relief.
- Journal
- Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association (Q1)
- Published
- 12 September 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Charalampos Pitsilos, Dimitrios Rigkos, Byron Chalidis
- PMID
- 42732080
- DOI
- 10.1002/arj.70537
Why clinicians should know about it
- Picked for Orthopedics and Sports Medicine (paper of the day, 14 September 2026): LP‑PRP injection during rotator cuff repair reduces failure rates
Abstract
PURPOSE: To evaluate the efficacy of injected leukocyte-poor platelet-rich plasma (LP-PRP) during arthroscopic rotator cuff repair, primarily in reducing failure rates and, secondarily, in improving shoulder function and clinical outcome. METHODS: A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Medline/PubMed, Scopus, Web of Science, and Cochrane databases were searched up to August 31, 2025, for comparative studies investigating the injectable LP-PRP during arthroscopic rotator cuff repair. Inclusion criteria were Level I or II studies reporting clinical and radiological outcomes with more than 6-month follow-up. Data were extracted on failure incidence and patient-reported outcome measures. Quantitative synthesis was performed using inverse variance weighting, and heterogeneity was assessed with the I2 statistic. RESULTS: Five randomized controlled trials (n = 470 patients; 235 LP-PRP, 235 control) were included. No difference was found in mean age (P = .760) and gender distribution (P = >.99) between the 2 study groups. Repair failure occurred in 34/213 (15.9%) in the LP-PRP group versus 63/217 (29.0%) in controls (odds ratio 2.16; 95% confidence interval 1.34-3.48; P = .001; relative risk 0.55; 95% confidence interval 0.38-0.79). The LP-PRP group showed greater improvements in Constant score at 6 months (31.6 vs 28.4; P = .001), 12 months (46.9 vs 44.2; P = .001), and 24 months (45.7 vs 42.8; P = .003), Single Assessment Numeric Evaluation at 12 months (42 vs 38.7; P = .036), University of California-Los Angeles at 6, 12, and 24 months (P < .001 for all), and visual analog scale at 3 months (5.9 vs 4.6; P = .001) and 24 months (5.2 vs 4.9; P = .012); nevertheless, none of these improvements reached the minimal clinically important difference. Complication rates were comparable between groups (9.4% vs 7.7%; P = .508). CONCLUSIONS: Injection of LP-PRP during rotator cuff repair appears to be a safe procedure that may increase the healing rate. However, it has not been associated with improvements in patient-reported outcome measures sufficient to reach the minimal clinically important difference. LEVEL OF EVIDENCE: Level II, systematic review of Level I and II randomized controlled trials.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.