Arthroscopic PRP gel augmentation at the tendon-bone interface accelerates functional recovery and structural healing...

This study aimed to evaluate whether intraoperative application of platelet-rich plasma (PRP) gel at the tendon-bone interface during arthroscopic rotator cuff repair enhances functional recovery, reduces pain, and improves tendon healing within the critical 6-month postoperative window-a pivotal period for retear risk, socioeconomic reintegration, and ERAS (Enhanced Recovery After Surgery) outcomes.

In this retrospective cohort study, 152 patients with full-thickness supraspinatus tears underwent arthroscopic repair. The PRP group (n = 91) received thrombin-activated PRP gel injected at the tendon-bone interface under direct arthroscopic visualization, while controls (n = 61) received standard repair alone. Functional outcomes (Constant-Murley Score [CMS], American Shoulder and Elbow Surgeons [ASES] score, Subjective Shoulder Value [SSV]) and pain (Visual Analog Scale [VAS]) were assessed preoperatively and at 6 months postoperatively. Tendon healing was evaluated via MRI using Sugaya classification and tendon thickness measurement.

At 6 months postoperatively, the PRP group demonstrated significantly greater improvements in all outcomes versus controls: Functional recovery: ΔCMS = 23.33 vs. 13.08 (p < 0.01); ΔASES = 45.56 vs. 38.78 (p < 0.01); SSV = 82.97% vs. 78.85% (p = 0.006); Pain reduction: ΔVAS = 3.97 vs. 3.51 (p < 0.01); Tendon healing: Sugaya grade distribution significantly favored the PRP group (p < 0.001), with 89.0% vs. 54.1% achieving favorable healing (I/II) and lower retear rates (IV/V: 2.2% vs. 13.1%); tendon thickness 0.63 ± 0.08 cm vs. 0.50 ± 0.06 cm (p < 0.001).

PRP gel application was associated significantly greater improvement in functional recovery, greater reduction in pain, and better structural healing at 6 months postoperatively. This approach may support the objectives of enhanced recovery pathways by potentially facilitating a timely return to productivity and reducing socioeconomic burdens, supporting its role as a cost-effective adjunct to rotator cuff repair.