Increased vascularization during early healing after biologic augmentation in repair of chronic rotator cuff tears using autologous leukocyte- and platelet-rich.

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Increased vascularization during early healing after biologic augmentation in repair of chronic rotator cuff tears using autologous leukocyte- and platelet-rich fibrin (L-PRF): a prospective randomized controlled pilot trial Matthias A. Zumstein, MD, Adam Rumian, MD, FRCS (Tr&Orth), Virginie Lesbats, MD, Michael Schaer, MD, Pascal Boileau, MD Journal of Shoulder and Elbow Surgery Volume 23, Issue 1, Pages 3-12 (January 2014) DOI: 10.1016/j.jse.2013.08.017 Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees Terms and Conditions

Figure 1 Preparation of 4 L-PRF clots according to the optimized protocol (A–D). Journal of Shoulder and Elbow Surgery 2014 23, 3-12DOI: (10.1016/j.jse.2013.08.017) Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees Terms and Conditions

Figure 2 Tendon vascularity measured on power Doppler analysis. (A) Single spots. (B) Multiple spots. (C) = Sectors. Journal of Shoulder and Elbow Surgery 2014 23, 3-12DOI: (10.1016/j.jse.2013.08.017) Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees Terms and Conditions

Figure 3 The supraspinatus tendon is depicted in normal long axis. The medial anchor was identified, and medial to it the medial vascularity area (blue) was defined. The remaining space was bisected to the intermediate (yellow) and lateral (orange) vascularity area. The location of the L-PRF between the tendon and the bone is represented schematically in the intermediate and lateral zones. LB, lateral bursal; LA, lateral articular; IB, intermediate bursal; IA, intermediate articular; MB, medial bursal; MA, medial articular. Journal of Shoulder and Elbow Surgery 2014 23, 3-12DOI: (10.1016/j.jse.2013.08.017) Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees Terms and Conditions

Figure 4 Mean vascularity index of the rotator cuff tears repaired with (L-PRF+) or without (L-PRF−) leukocyte- and platelet-rich fibrin and the contralateral (CTRL) group. Significant differences between the groups are marked with an asterisk. Journal of Shoulder and Elbow Surgery 2014 23, 3-12DOI: (10.1016/j.jse.2013.08.017) Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees Terms and Conditions

Figure 5 Mean vascularity in the subareas at 6 weeks. Journal of Shoulder and Elbow Surgery 2014 23, 3-12DOI: (10.1016/j.jse.2013.08.017) Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees Terms and Conditions

Figure 6 Complete watertight healing at 3-month follow-up in the L-PRF+ group measured on the magnetic resonance arthrogram. Journal of Shoulder and Elbow Surgery 2014 23, 3-12DOI: (10.1016/j.jse.2013.08.017) Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees Terms and Conditions