Patient-reported outcomes after arthroscopic wrist debridement using platelet-rich plasma glue compared to standard arthroscopic debridement
Emma D. Vartanian1, Tiffany Calero2, David A. Kulber1,3 1. Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, CA 2. Keck School of Medicine of the University of Southern California, Los Angeles, CA 3. Department of Orthopedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
Background: Arthroscopic debridement has been shown to reduce wrist pain and improve functional outcomes in triangular fibrocartilage complex (TFCC) tears, however many patients require secondary procedures. In recent years, platelet-rich plasma has been increasingly used to treat musculoskeletal pathologies, however empiric data is lacking. Our institution developed a protocol to investigate healing potential from injection of platelet-rich plasma (PRP) at the time of TFCC debridement. The aim of this study was to evaluate patient-reported outcomes following wrist arthroscopy with PRP injection, compared to outcomes after standard arthroscopy and debridement.
Methods: We retrospectively identified all patients who underwent wrist arthroscopic debridement from 2013 to 2020. Operative reports were reviewed to confirm TFCC injury. After thorough debridement of the torn ligament, a subset of patients received an injection of PRP glue into the injured area. The PRP was collected using our institutional centrifugation protocol and mixed with thrombin prior to injection. All patients were subsequently surveyed at clinic visits regarding postoperative pain scores, wrist function, and quality of life.
Results: A total of 52 patients were identified with suspected TFCC tears who underwent wrist arthroscopy with debridement. The control group of standard arthroscopy consisted of 30 patients and the PRP-enhanced group consisted of 22 patients. Length of follow-up ranged between one to four years. On a 1-10 pain scale, both groups had comparable preoperative wrist pain; 6.5 for the control group and 6.4 for the PRP group. At final clinic follow-up, the PRP-enhanced group reported lower post-operative pain with an average of 2.2, a significant reduction compared to pre-operative levels (p<0.05). However, post-operative pain for control patients was also significantly lower, at 1.6. There was no significant difference between groups. Among PRP patients, 77% reported improvement in wrist range of motion and 82% reported improved quality of life, compared to 84% and 92% of standard arthroscopy patients.
Conclusion: All patients with TFCC tears experienced significant pain relief and improved quality of life after arthroscopic wrist debridement, regardless of PRP injection. The control group overall demonstrated equivalent pain reduction as the PRP-enhanced group. While we established this technique is a safe and efficacious means to improve chronic wrist pain from TFCC tears, it does not demonstrate superior outcomes. The additional operating time and expense involved in the use PRP for wrist arthroscopy cannot be justified without further research supporting its potential to enhance ligament healing.
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