Presentation at the Western Orthopaedic Association Annual Meeting 2009 - Enhancing SLAP repairs with Fibrin-PRP clots

1. Enhancing SLAP Repairs with
Fibrin-PRP Clots
Alan M Hirahara, MD, FRCSC*
Kyle Yamashiro, PT#
Russell Dunning, MSPT#
* Private Practice
# Results Physical Therapy
Sacramento, CA USA

2. Objective of Study
 To evaluate the outcomes of SLAP repairs
with and without a fibrin platelet-rich
plasma (PRP) clot
 To overcome physiologic barriers by
enhancing SLAP repairs with biologic
components

3. Introduction
 In the literature, 20% non-healing of SLAP
repairs reported
 Fibrin clots - Improved healing with meniscal
repairs but technically challenging with
arthroscopy
 Platelet-Rich Plasma (PRP) - Improved
healing of soft tissues & bone

4. Study Design
 Case-control study
 Collection period: 1/07 – 12/08

5. Study Design
 Same surgeon & physical therapist
 Inclusions: All patients with a SLAP repair
(includes other shoulder pathology)
 Exclusions: Any trauma post-op
 Failure to heal: Evaluated any complaints
or symptoms 4-6 months post-op with
repeat MRA or surgery

6. Patient Data
Control Group Study Group
 39 patients  139 patients
 23 male (59%), 16 female  85 male (61%), 54 female
 Age range: 18 – 66 years  Age range: 13 – 77 years
 Age average: 43.09 years  Age average: 45.80 years

7. Fibrin-PRP Clot Technique
 60 cc autologous blood drawn pre-op
 Using Plasmax system, blood spun for 8 minutes
at 3200 RPM
 Platelet Rich-Plasma (PRP) collected
 Platelet Poor-Plasma (PPP) spun for 2 minutes
at 2000 RPM
 Fibrin collected

8. Fibrin-PRP Clot Technique
 Fibrin : PRP ratio = 9 : 3 cc
 Debride bone surface
 Place BiosutureTak anchors & pass sutures
 Clot formed in-situ between tissue & bone
 Tie sutures

9. # Anchors used for SLAP Repair
Control Group Study Group
60 57
18 17
16 50 45
14
40
12
10 30
22
8 7 7
20
6 5 12
4 3 10
3
2
0
0 1 2 3 4 5
1 2 3 4 5
Average # anchors used: 2.90 Average # anchors used: 2.40

10. Associated Pathology
Control Group Study Group
90
86 85
25 23
80
20 70
60
15
14
50
11 41
40
10
30 23
19
20
5
1 10 3
0 0
0 0

11. Pain Scores
p = NS p = NS p < 0.001 p < 0.05
8.0 7.1 7.2
7.0 6.0
6.0
5.2
4.8
5.0
4.0 2.9 3.1
3.0 1.7
2.0
1.0
0.0
Pre-op 1 Month 3 Month 6 Month
Control Group Study Group

12. ASES Scores
p = NS p < 0.05 p < 0.001 p = 0.06
82.1
90.0
71.9 72.7
80.0
70.0 56.3
60.0 45.6
42.2
50.0 35.9 36.9
40.0
30.0
20.0
10.0
0.0
Pre-op 1 Month 3 Month 6 Month
Control Group Study Group

13. Days to Discharge
p < 0.001
250.0 213.5
200.0
122.5
150.0
Days
100.0
50.0
0.0
Control Group Study Group

14. Return to Work
p < 0.01
140.0
121.7
120.0
100.0
62.3
80.0
Days
60.0
40.0
20.0
0.0
Control Group Study Group

15. Failure to Heal
p = 0.008
12.00% 10.26%
10.00%
8.00% 4/39
6.00%
4.00%
0.72%
2.00%
1/139
0.00%
Control Group Study Group

16. Results
 Improved pain scores by 3 months
 Improved ASES scores by 1 months
 Improved time to discharge by 91 days
 Improved return to work by 59.4 days
 Improved failure rate from 10.3% to 0.7%
 All statistically significant

17. Discussion
 Fibrin-PRP clots – Ensures healing
process is initiated properly where needed
 Anatomy of SLAP counter to clot formation
 Combines structural (fibrin) & healing (PRP)
components
 Randomized, multicenter study already
begun to confirm results

18. Conclusion
 Fibrin-PRP clots enhance SLAP
repairs resulting in:
 Reliable Healing
 Fewer Revisions
 Less Pain
 Faster Recovery

19. Thank You