Biologics in Shoulder Surgery

Rotator Cuff Repair

Rotator cuff repair (RCR) is a common orthopedic procedure, yet structural failure remains a significant challenge. Retear rates have been reported as high as 15% to 34%, particularly in large or complex tears.^1,2

Enhance Tendon Healing With PRP

Platelet-rich plasma (PRP) augmentation aims to enhance healing by delivering concentrated growth factors directly to the injured site.

Patients receiving PRP experienced an average

63%

lower risk of retear compared to standard repair alone.^3,5-7,9-11

‍

PRP reduces retear rates and offers early improvements in functional outcomes.

Enhance Tendon Healing With PRP

Scientific Insights

Multiple Level I studies demonstrate that intraoperative PRP application reduces structural failure and improves early recovery, addressing one of the key limitations of conventional repair.

Adding PRP to rotator cuff repair shows significant benefits compared to standard repair alone.

Retear Rate: 63% less likely to retear after receiving PRP during RCR surgery^3,5-7,9-10
VAS Scores: 45% lower at 1-month follow-up^4,7,8
Improved Clinical Scores: 3 to 24 months post-op^8-7

References

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Key Takeaways

PRP significantly reduces retear rates when used during arthroscopic rotator cuff repair
Functional outcomes (eg, pain, strength) show early improvements

Study Limitations

Variability in PRP preparation and application must be considered when comparing results
Clinical benefits are not uniformly reported; nevertheless, the reduction in retear rates supports its use as an adjunct in surgical repair

Enhance Tendon Healing With PRP

References

Longo UG, Carnevale A, Piergentili I, et al. Retear rates after rotator cuff surgery: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2021;22(1):749. doi:10.1186/s12891-021-04634-6
Mandaleson A. Re-tears after rotator cuff repair: Current concepts review. J Clin Orthop Trauma. 2021;19:168-174. doi:10.1016/j.jcot.2021.05.019
Barber FA, Hrnack SA, Snyder SJ, Hapa O. Rotator cuff repair healing influenced by platelet-rich plasma construct augmentation. Arthroscopy. 2011;27(8):1029-1035. doi:10.1016/j.arthro.2011.06.010
D’Ambrosi R, Palumbo F, Paronzini A, Ragone V, Facchini RM. Platelet-rich plasma supplementation in arthroscopic repair of full-thickness rotator cuff tears: a randomized clinical trial. Musculoskelet Surg. 2016;100(Suppl 1):25-32. doi:10.1007/s12306-016-0415-2
Jo CH, Shin JS, Lee YG, et al. Platelet-rich plasma for arthroscopic repair of large to massive rotator cuff tears: a randomized, single-blind, parallel-group trial. Am J Sports Med. 2013;41(10):2240-2248. doi:10.1177/0363546513497925
Jo CH, Shin JS, Shin WH, Lee SY, Yoon KS, Shin S. Platelet-rich plasma for arthroscopic repair of medium to large rotator cuff tears: a randomized controlled trial. Am J Sports Med. 2015;43(9):2102-2110. doi:10.1177/0363546515587081
Pandey V, Bandi A, Madi S, et al. Does application of moderately concentrated platelet-rich plasma improve clinical and structural outcome after arthroscopic repair of medium-sized to large rotator cuff tear? A randomized controlled trial. J Shoulder Elbow Surg. 2016;25(8):1312-1322. doi:10.1016/j.jse.2016.01.036
Randelli P, Arrigoni P, Ragone V, Aliprandi A, Cabitza P. Platelet rich plasma in arthroscopic rotator cuff repair: a prospective RCT study, 2-year follow-up. J Shoulder Elbow Surg. 2011;20(4):518-528. doi:10.1016/j.jse.2011.02.008
Rossi LA, Gorodischer TD, Camino P, et al. Leukocyte-poor platelet-rich plasma as an adjuvant to arthroscopic rotator cuff repair reduces the retear rate but does not improve functional outcomes: a double-blind randomized controlled trial. Am J Sports Med. 2024;52(6):1403-1410. doi:10.1177/03635465241239062
Zhang C, Cai YZ, Wang Y. Injection of leukocyte-poor platelet-rich plasma for moderate-to-large rotator cuff tears does not improve clinical outcomes but reduces retear rates and fatty infiltration: A prospective, single-blinded randomized study. Arthroscopy. 2022;38(8):2381-2388.e1. doi:10.1016/j.arthro.2022.02.007
Zhang Z, Wang Y, Sun J. The effect of platelet-rich plasma on arthroscopic double-row rotator cuff repair: a clinical study with 12-month follow-up. Acta Orthop Traumatol Turc. 2016;50(2):191-197. doi:10.3944/AOTT.2015.15.0113

Scientific Insights

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Arthrex ACP® System

Produces 100% autologous PRP for tissue healing and regeneration

ACP Max™ System

Delivers highly concentrated PRP rich in growth factors for tissue healing

Angel® System

Prepares highly concentrated PRP or bone marrow concentrate containing regenerative cells

Thrombinator™ System

Rapidly generates autologous thrombin serum to enhance graft handling; produces platelet-rich fibrin with the addition of PRP

Arthroplasty

Total shoulder arthroplasty is highly effective for end‑stage joint disease, yet it often comes with significant blood loss, transfusion needs, pain, and slower wound healing—factors that can prolong recovery.

Arthroplasty and Biologics: Advancing Outcomes

PRP, fibrin sealants, and thrombin-based agents leverage autologous or active components to improve hemostasis, reduce inflammation, and aid tissue repair.

Biologic adjuncts such as PRP deliver significant reductions in pain and opioid use.¹⁴

PRP and autologous fibrin sealants are safe and effective.

Arthroplasty and Biologics: Advancing Outcomes

Scientific Insights

Current evidence from 15 studies including 8 randomized controlled trials demonstrates promising results across multiple clinical end points.

Pain Reduction^{7,8,11,14,15
‍}Statistically significant short-term pain reduction in TKA and TSA‍
Narcotic Requirements^7,14,15
‍28-53% reduction in opioid consumption in TKA‍
Functionality^7,11,14
‍Faster functional recovery in TKA and TSA
Blood Loss^{1-5,7,9,12,13,15
‍}TKA: up to 22% Hb drop reduction
THA: up to 32% Hb drop reduction
Wound Healing^6,10Accelerated wound healing in THA

References

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Key Takeaways

PRP improves early pain scores and range of motion after TKA
Fibrin sealants and thrombin-based agents significantly lower transfusion rates
PRP and autologous fibrin sealants are safe

Study Limitations

Heterogeneity in PRP preparation methods across studies
Diverse endpoints and variable follow-up intervals
Most benefits observed are short-term perioperative outcomes

Arthroplasty and Biologics: Advancing Outcomes

References

Romanò CL, Monti L, Logoluso N, Romanò D, Drago L. Does a thrombin-based topical haemostatic agent reduce blood loss and transfusion requirements after total knee revision surgery? A randomized, controlled trial. Knee Surg Sports Traumatol Arthrosc. 2015;23(11):3337-3342. doi:10.1007/s00167-014-3153-8
Li ZJ, Fu X, Tian P, et al. Fibrin sealant before wound closure in total knee arthroplasty reduced blood loss: a meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2015;23(7):2019-2025. doi:10.1007/s00167-014-2898-4
Bloomfield MR, Klika AK, Molloy RM, Froimson MI, Krebs VE, Barsoum WK. Prospective randomized evaluation of a collagen/thrombin and autologous platelet hemostatic agent during total knee arthroplasty. J Arthroplasty. 2012;27(5):695-702. doi:10.1016/j.arth.2011.09.014
Qu Z, Wang G, Xu C, et al. The effects of platelet apheresis on blood saving and coagulation in bilateral total hip replacement: A prospective study on 60 patients. Int J Surg. 2016;34:58-63. doi:10.1016/j.ijsu.2016.08.233
Everts PA, Devilee RJ, Brown Mahoney C, et al. Platelet gel and fibrin sealant reduce allogeneic blood transfusions in total knee arthroplasty. Acta Anaesthesiol Scand. 2006;50(5):593-599. doi:10.1111/j.1399-6576.2006.001005.x
Capion SC, Jørgensen HBL, Ågren MS, et al. The wound healing effect of local leukocyte platelet-rich plasma after total hip arthroplasty: A randomized controlled trial. Wound Repair Regen. 2021;29(6):988-995. doi:10.1111/wrr.12967
Aggarwal AK, Shashikanth VS, Marwaha N. Platelet-rich plasma prevents blood loss and pain and enhances early functional outcome after total knee arthroplasty: a prospective randomised controlled study. Int Orthop. 2014;38(2):387-395. doi:10.1007/s00264-013-2136-6
Muchedzi TA, Roberts SB. A systematic review of the effects of platelet rich plasma on outcomes for patients with knee osteoarthritis and following total knee arthroplasty. Surgeon. 2018;16(4):250-258. doi:10.1016/j. surge.2017.08.004
Mochizuki T, Yano K, Ikari K, et al. Platelet-rich plasma for the reduction of blood loss after total knee arthroplasty: a clinical trial. Eur J Orthop Surg Traumatol. 2016;26(8):901-905. doi:10.1007/s00590-016-1821-8
Shu H, Huang Z, Bai X, et al. The Application of Platelet-Rich Plasma for Patients Following Total Joint Replacement: A Meta-Analysis of Randomized Controlled Trials and Systematic Review. Front Surg. 2022;9:922637. doi:10.3389/fsurg.2022.922637
Li FX, Li Y, Qiao CW, Zhu J, Chen J, Zhang PY. Topical use of platelet-rich plasma can improve the clinical outcomes after total knee arthroplasty: A systematic review and meta-analysis of 1316 patients. Int J Surg. 2017;38:109-116. doi:10.1016/j.ijsu.2016.12.013
Ma J, Sun J, Guo W, Li Z, Wang B, Wang W. The effect of platelet-rich plasma on reducing blood loss after total knee arthroplasty: A systematic review and meta-analysis. Medicine (Baltimore). 2017;96(26):e7262. doi:10.1097/ MD.0000000000007262
Wang X, Ma J, Wang Z, Xiao L. The clinical efficacy of using autologous platelet-rich plasma in total hip arthroplasty: A retrospective comparative study. Medicine. 2018;97(40):e12451. doi:10.1097/MD.0000000000012451
Zavadil DP, Satterlee CC, Costigan JM, Holt DW, Shostrom VK. Autologous platelet gel and platelet-poor plasma reduce pain with total shoulder arthroplasty. J Extra Corpor Technol. 2007;39(3):177-182.
Gardner MJ, Demetrakopoulos D, Klepchick PR, Mooar PA. The efficacy of autologous platelet gel in pain control and blood loss in total knee arthroplasty. An analysis of the haemoglobin, narcotic requirement and range of motion. Int Orthop. 2007;31(3):309-313. doi:10.1007/ s00264-006-0174-z