The exact role of platelet-rich plasma (PRP) in rotator cuff tendon reconstruction remains unclear. This study investigated whether an intraoperative pure PRP injection, compared with a local anesthetic injection, improves patient-reported outcomes at 3 and 6 months after arthroscopic rotator cuff repair. The hypothesis was that pure PRP improves patient-reported outcomes (Oxford Shoulder Score [OSS]) at 3 and 6 months after surgery and has the same pain-reducing effect compared with a postoperative subacromial local anesthetic (ropivacaine) injection. Randomized controlled trial; Level of evidence, 1. Between January 2011 and November 2012, a total of 120 patients who underwent arthroscopic double-row repair of a supraspinatus tendon rupture were randomized to receive either pure PRP by an injection at the footprint (PRP group; n = 60) or ropivacaine injected in the subacromial region (control group; n = 60). Seventy-eight percent of patients had other concomitant tears. All patients, surgeons, and follow-up investigators were blinded. Clinical parameters and various outcome scores (Constant-Murley shoulder score; OSS; patient American Shoulder and Elbow Surgeons score; quick Disabilities of the Arm, Shoulder and Hand score; EuroQol 5 dimensions) were documented preoperatively and at 3, 6, and 24 months postoperatively. The repair integrity was assessed by magnetic resonance imaging or ultrasound at 24 months. Furthermore, a pain diary was completed within the first 10 postoperative days, and adverse events were recorded. Group outcome differences were analyzed using t tests, Fisher exact tests, and mixed models. The final follow-up rate was 91%. An associated tear of the subscapularis tendon was diagnosed in 23% of PRP-treated patients and 36% of control patients. Three months after surgery, the mean (±SD) OSS was 32.9 ± 8.6 in PRP-treated patients and 30.7 ± 10.0 in control patients (P = .221). No significant differences were noted for other outcome parameters as well as at 6 and 24 months postoperatively. Smoking was a significant effect modifier. Pain for both groups decreased from postoperative day 1 to 10 without any significant group difference (P = .864). Six (12.2%) and 11 (20.8%) patients were diagnosed with a recurrent supraspinatus tendon defect in the PRP and control groups, respectively (P = .295). Twenty-two (40.7%) and 18 (30.5%) PRP-treated and control patients, respectively, experienced a local adverse event within 24 months (P = .325). Patients treated with pure PRP showed no significantly improved function at 3, 6, and 24 months after arthroscopic repair compared with control patients receiving ropivacaine; however, a similar pain reduction was documented in both groups. The negative influence of smoking on the effect of pure PRP requires further investigation. NCT01266226 (ClinicalTrials.gov).

Background: Implant functionality has clearly increased over the past decades because of improvements in total shoulder arthroplasty systems. This means that prostheses are now being implanted in younger patients with high sports activity. Hypothesis: The implantation of the total shoulder arthroplasty does not mainly influence the sports activity. Study Design: Case series; Level of evidence, 4. Methods: One hundred consecutive patients with unilateral total shoulder arthroplasty, followed for at least 1 year, were included in the study. Assessment preoperatively and 1 year and 2 years after operation included clinical examination and a validated questionnaire (Constant, Shoulder Pain and Disability Index [SPADI], and Disabilities of the Arm, Shoulder and Hand [DASH] scores, and the Short Form 36 [SF-36]). In addition, all patients received a sports questionnaire developed in house. Results: Of the 55 patients who took part in sports before having shoulder disease, 49 (89%) were still able to participate after a mean follow-up of 2.8 years (range, 1.3-4.6 years). Seventeen patients had given up sports before total shoulder arthroplasty; 11 of them resumed activities after joint replacement but 6 did not start again. No patient had to stop sports because of the total shoulder arthroplasty. The sports most commonly mentioned were swimming (10 patients [20.4%]), golf (8 patients [16.3%]), cycling (8 patients [16.3%]), and fitness training (8 patients [16.3%]). Strength and range of motion, as well as the physical component summary (PCS) of the SF-36 and the Constant score (CS) after total shoulder arthroplasty, were significantly better in the sports group (49 of 100; PCS = 46, CS = 77) than in the nonsports group (45 of 100; PCS = 41,CS = 71). Eighteen patients (36.7%) stated that even after joint replacement, they still suffered restrictions on their sports activities because of shoulder problems. Whereas the overall mean age at follow-up was 68.9 years (range, 26-92 years), the mean age of patients participating in sports was significantly lower than in the nonsports group (63 vs 70 years; P = .002). Conclusion: Total shoulder arthroplasty allows patients to participate in sports without significant restriction of their level of activity. The probability of being able to do sports postoperatively—if done preoperatively—is high. Long-term studies are needed to determine whether the greater loading on the joint will lead to more rapid wear and a higher rate of loosening with time.

Objective: To assess quantitatively the outcome and to explore the physiometric and psychometric properties of clinical, generic, and condition‐specific instruments after total elbow arthroplasty.Methods: Seventy‐nine patients were assessed in a 6–19‐year cross‐sectional catamnesis by means of 6 widely used questionnaires, clinical examinations, and radiographic examinations.Results: With regard to pain, general physical health, and all the mental health dimensions of the Short Form 36 (SF‐36), the patients showed scores comparable to normative values. Elbow joint stability and satisfaction were both good. Significant functional limitation was evidenced by the low mean scores of the SF‐36 physical functioning measure (48.7, normative 69.9) and the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) function measure (51.1, normative 89.3). The SF‐36 physical component summary and the DASH correlated highly (r = 0.76) and, in factor analysis, loaded on the factor “physical unspecific.” The patient and clinical modified American Shoulder and Elbow Surgeons questionnaire (mASES) correlated with the Patient Related Elbow Evaluation form (r = 0.92 with the patient mASES) and loaded on “physical specific.” The SF‐36 mental component summary loaded on “mental quality of life.”Conclusion: The patients' self‐rated health, quality of life, and clinical outcome were good and were not affected by impairment in some specific functional abilities. A questionnaire set comprising the SF‐36 and the patient and clinical mASES is proposed for the comprehensive and specific assessment of outcome after elbow arthroplasty.