Enhancing SLAP Repairs with Fibrin-PRP Clots
Authors: Alan M Hirahara, Kyle Yamashiro, Russ Dunning
References: Presented at the 76th Arthroscopy Association of North America, San Diego, April 30 - May 3, 2009
Purpose: The purpose of this study was to evaluate the failure rates of SLAP repairs with and without a
fibrin platelet-rich plasma (PRP) clot.
Methods: 139 patients received a fibrin-PRP clot, placed arthroscopically between the labrum and bone prior to tying our sutures in repairing the SLAP lesion. Thirty-nine patients were repaired without use of a fibrin-PRP clot. Arthroscopic fixation was performed using a bioabsorbable suture anchor (Bio-SutureTak, Arthrex, Naples FL). The fibrin-PRP clot was made from autologous blood, using the Plasmax Plus system (Biomet Biologics,Warsaw IN). We did not exclude patients who had associated pathology (rotator cuff, AC arthropathy, instability, etc.). Patients were evaluated clinically with ASES scores, range of motion, time to discharge, and time to return to work. Repeat MRA or surgery was performed for people having persistent pain or complaints at four to six months post-operatively to evaluate healing.
Results: Four out of thirty-nine (10.3%) control patients failed to heal and required revision surgery to repair their SLAP lesions. One out of 139 (0.7%) study patients failed to heal (p = 0.008). Pain scores steadily decreased from pre-op to 1 month to 3 months to 6 months in both groups but significantly greater in the study group (7.1, 5.2, 3.0, 1.7) compared with the control group (7.1, 6.0, 4.8, 3.1) (p=NS, NS, < 0.001, < 0.05). ASES society scores increased steadily from pre-op to 1 month to 3 months to 6 months in both groups. The control group increased from 35.9 to 36.9 to 56.3 to 72.7. The study group increased from 43.1 to 45.2 to 71.0 to 81.9 and were significantly different (p = NS, < 0.05, < 0.001, 0.06). The average days to discharge in the study group was significantly improved at 119.1 days from 213.5 in the control group (p < 0.001). Time to return to work decreased from control to the study group 121.7 days to 57.1 days (p < 0.01). ROM increased in both groups non-significantly from pre-op to 3 months follow up in the study group (72.6 to 161.6 degrees forward flexion, 14.7 to 77.8 degree external rotation, 68.9 to 158.8 degrees abduction) and in the control group (77.6 degrees to 159.9 degrees forward flexion, 24.8 to 80.9 degrees external rotation, 72.0 to 155.7 degrees abduction).
Conclusions: The results of this study show that the fibrin-PRP clot enhances the healing of the labrum to the glenoid. There were significantly fewer failures, less pain, quicker time to discharge, and faster functional recovery. ROMall increased in both groups to a similar extent given that we used the same therapy protocol for both groups. By suturing a fibrin-PRP clot between the labrum and glenoid, recovery and healing of the tear occurs quicker and more reliably.