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Scientific Articles   |    
Use of Platelet-Leukocyte Membrane in Arthroscopic Repair of Large Rotator Cuff TearsA Prospective Randomized Study
Stefano Gumina, MD, PhD1; Vincenzo Campagna, MD2; Giancarlo Ferrazza, MD3; Giuseppe Giannicola, MD1; Francesco Fratalocchi, PHT4; Alessandra Milani, MS5; Franco Postacchini, MD1
1 Department of Orthopaedics and Traumatology, University of me “Sapienza,” Piazzale Aldo Moro 5, 00185, Rome, Italy. E-mail address for S. Gumina: s.gumina@tiscali.it. E-mail address for G. Giannicola: Giannicola.g@tin.it. E-mail address for F. Postacchini: franco.postacchini@uniroma1.it
2 Orthopaedic Department, Military Hospital “Celio,” Via de Santo Stefano Rotondo 4, 00184 Rome, Italy. E-mail address: campagnav@virgilio.it
3 Immunohaematology and Transfusion Service, University of Rome “Sapienza,” Piazzale Aldo Moro 5, 00185, Rome, Italy. E-mail address: Giancarlo.ferrazza@uniroma1.it
4 Private Office of Physical Therapy, Via Tacito 74, 00193, Rome, Italy. E-mail address: f.fratalocchi@alice.it
5 National Statistical Institute (ISTAT), Via Cesare Balbo 16, 00184, Rome, Italy. E-mail address: alemilani@quipo.it
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Investigation performed at the Orthopaedic Clinic, University of Rome “Sapienza,” Rome, Italy

A commentary by Donald H. Lee, MD, is linked to the online version of this article at jbjs.org.



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 Aug 01;94(15):1345-1352. doi: 10.2106/JBJS.K.00394
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Abstract

Background: 

Arthroscopic rotator cuff repair generally provides satisfactory results including decreased shoulder pain and improved shoulder motion. Unfortunately, imaging studies demonstrate that the retear rate associated with the available arthroscopic techniques may be high. The purpose of this study was to evaluate the clinical and magnetic resonance imaging (MRI) results of arthroscopic rotator cuff repair with and without the use of platelet-leukocyte membrane in patients with a large posterosuperior rotator cuff tear.

Methods: 

Eighty consecutive patients with a large full-thickness posterosuperior rotator cuff tear were enrolled. All tears were repaired using an arthroscopic single-row technique. Patients were randomized to treatment either with or without a platelet-leukocyte membrane inserted between the rotator cuff tendon and its footprint. In patients treated with this membrane, one membrane was utilized for each suture anchor. The primary outcomes were the difference between the preoperative and postoperative Constant scores and the repair integrity assessed by MRI according to the Sugaya classification. The secondary outcome was the difference between the preoperative and postoperative Simple Shoulder Test (SST) scores.

Results: 

The only significant differences between the two groups involved the patient age and the preoperative and postoperative Constant scores; the differences in the Constant score were due to differences in the shoulder pain subscore. At a mean of thirteen months of follow-up, rotator cuff retears were observed only in the group of patients in whom the membrane had not been used, and a thin but intact tendon was observed more frequently in this group as well. The use of the membrane was associated with significantly better repair integrity (p = 0.04).

Conclusions: 

The use of the platelet-leukocyte membrane in the treatment of rotator cuff tears improved repair integrity compared with repair without membrane. However, the improvement in repair integrity was not associated with greater improvement in the functional outcome. In fact, the Constant scores of the two groups would have been similar if the shoulder pain component (which had differed preoperatively) had been excluded.

Level of Evidence: 

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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