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Platelet-Rich Fibrin Matrix Has a Negative Effect on Tendon Healing

Surgeons from the Sports Medicine and Shoulder Service at the Hospital for Special Surgery in New York City add a new piece of information about platelet-rich plasma for tendon healing. In their study using this healing method for rotator cuff tears, patients had a worse outcome compared to the control group who had the same surgery but without the use of a platelet-rich fibrin matrix.

Let's back up a bit and fill you in on what this all means. In the past 10 years, surgeons have started using platelet-rich plasma (PRP) (also known as blood injection therapy) for a wide range of musculoskeletal problems.

Platelet-rich plasma (PRP) refers to a sample of serum (blood) plasma that has as much as four times more than the normal amount of platelets. This treatment enhances the body’s natural ability to heal itself. It is used to improve healing and shorten recovery time from acute and chronic soft tissue injuries.

In this study, the surgeons used a special platelet-rich fibrin matrix (PRFM) they made themselves in the operating room. It is a slight variation from the original platelet-rich plasma (PRP) product first used. The fibrin matrix processes the patient's plasma in a way that helps keep blood-clotting platelets in the matrix while also slowly releasing cytokines to aid in healing.

Cytokines are signaling molecules used in cellular communication. They are part of the immune system response to injury. They help set up a new blood supply to the area and attract stem cells to the area to help form new tendon. By painting this substance at the tendon-bone interface, the researchers hoped to speed up rotator cuff healing.

Instead, what they found with ultrasound studies and by measuring patients' motion, strength, and function was that the group who did NOT receive the PRFM got better results. The two groups (with and without the PRFM) had similar outcomes in terms of grip strength and pain after surgery. But the PRFM group had a significantly higher number of tendon defects. This finding indicated the PRFM might have a negative effect on tendon healing.

The original hypothesis in conducting this study was that PRFM would speed up or accelerate rotator cuff tendon healing. It did not. In fact, it seemed to inhibit healing. There were more treatment failures in the PRFM group compared with the control group. Of course, the natural question is, "Why didn't it work?"

The authors propose three possibilities: 1) the study was fairly small (39 patients in one group, 40 in the other), 2) the study only looked at tendon results with ultrasound 12 weeks out; it is possible that further tendon healing took place much later, and 3) the method used to make the matrix could be improved. They took the patients' plasma and used it without analyzing exactly how many of each kind of cells (e.g., platelets, growth factors, cytokines, white blood cells) were present.

Although PRFM did not improve rotator cuff tendon healing and was even linked with lower healing rates, further study is needed to understand what happened before either abandoning the technique or using it on other patients.


Scott A. Rodeo, MD, et al. The Effect of Platelet-Rich Fibrin Matrix on Rotator Cuff Tendon Healing. In The American Journal of Sports Medicine. June 2012. Vol. 40. No. 6. Pp. 1234-1241.

08/16/2012

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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