Clinical bottom line
Platelet-rich plasma (PRP) therapy as an adjunct in rotator cuff repair shows potential to enhance tendon healing and improve clinical outcomes, but current evidence remains mixed. Recent systematic reviews and meta-analyses suggest modest benefits in pain reduction and functional scores, with some indication of improved structural integrity on imaging. However, heterogeneity in PRP preparation, application techniques, and study designs limits definitive conclusions. PRP may be considered in select patients, especially those at higher risk of repair failure, but standardized protocols and further high-quality trials are needed to clarify its role (Rout et al., 2025; Rosso et al., 2023).
What the evidence shows
Rout et al. (2025) conducted a systematic review and meta-analysis evaluating PRP in rotator cuff tears, finding that PRP use was associated with statistically significant improvements in pain scores and shoulder function compared to controls. Imaging studies suggested a trend toward lower retear rates, although results varied.
Rosso et al. (2023) critically reviewed the literature on PRP in shoulder pathologies, noting that while biological augmentation with PRP is promising, inconsistencies in platelet concentration, activation methods, and delivery limit comparability. They emphasized the need for standardized preparation and reporting.
Le et al. (2018) provide broader clinical recommendations for PRP use in musculoskeletal conditions, highlighting that rotator cuff repair is among the indications with emerging but not yet definitive evidence.
Preclinical studies, including those exploring PRP combined with biomaterials (e.g., freeze-dried chitosan-thrombin-PRP implants), demonstrate enhanced tendon regeneration in animal models, suggesting mechanistic plausibility (reference omitted due to lack of vetted source).
Caveats and uncertainty
Significant variability exists in PRP formulations (leukocyte-rich vs. leukocyte-poor), platelet concentrations, and activation protocols, impacting efficacy.
Heterogeneous patient populations and tear characteristics complicate interpretation of clinical outcomes.
Most trials have short to medium-term follow-up; long-term durability of PRP benefits is unclear.
Potential publication bias and small sample sizes in some studies may inflate effect estimates.
Optimal timing and method of PRP application during surgery remain undefined.
How this may change practice
Orthopedic surgeons may consider PRP as an adjunct in rotator cuff repair for patients with large or complex tears or those at risk for poor healing.
Discussion with patients should include the current uncertainty regarding magnitude and durability of benefits.
Standardization of PRP protocols within institutions may improve consistency and facilitate outcome tracking.
Referral to clinical trials investigating optimized PRP formulations and delivery methods is encouraged.
Continued integration of biological augmentation approaches alongside surgical technique advances may improve repair success.