Shoulder & Elbow

Platelet-rich fibrin

As “sure as eggs is eggs”, the industry will continue to develop new and attractive treatment options to tempt the surgeon into using a more modern (and usually more expensive) surgical technique. Hot on the heels of the now mostly rejected platelet-rich plasma (PRP), we have platelet-rich fibrin (PRF). We are delighted to see researchers in Nice (France) conducting some clinical trials on this new technology (which may well, after all, offer little advantage over PRP) prior to advocating widespread clinical use. Noting that achieving tendon healing in the arthroplasty shoulder to bone is a challenge, these investigators conducted a small pilot series with this new technique. The research team introduce a leukocyte- and platelet-rich fibrin gel under arthroscopic control following the rotator cuff repair. The pilot study consisted of 20 patients randomly allocated to either PRF or standard treatment. Rotator cuff repair was achieved with a double-row technique and outcome measures were assessed using the subjective shoulder value, visual analogue scale, Constant, and Simple Shoulder Test scores. Interestingly, these investigators also included Doppler ultrasonography to measure the vascularisation of the cuff tendons. While the research team were unable to establish any differences in the clinical outcome measures (you wouldn’t necessarily expect them to), they did establish that the vascularisation index measured on ultrasound was significantly higher in the L-PRF group than in the contralateral healthy shoulders at six and 12 weeks.⁴ While this pilot study does show some encouraging results with no clinically reported differences, an improved vascularity on ultrasound would not justify use of this technology. It would, however, suggest that there may be a clinical effect in a larger study. This will have to be proven in larger trials.