Does PRP Help For Rotator Cuff Healing? Beware the

*Another Rotator Cuff PRP Article With Misleading Data Conclusions*
This time the article is published in the Journal of Arthroscopy this month. The authors are from China.
Summary: Arthoscopic Surgery Combined with PRP Does Not Improve Pain, Function, Complications, and Retear Rate Compared To Surgery Alone: Meta-analysis and sytematic review.
There are too many issues to list.
#1 The authors define the dose of PRP as simply being the volume. This is wrong. The dose of PRP is volume times the PRP concentration.
#2 After culling thru hundreds of articles the authors settled on 9 articles for inclusion in this paper. 3 out of 9 articles used a system (Arthrex ACP) that the company does not even call PRP because the "platelet" dose averages about 1 Billion platelets (J. Magalon, see images). Scratch those three articles because the end product doesn't meet criteria to be called PRP because the dose is so low.
4 out of 9 articles used a system (Biomet GPS II Plasmax) that despite a 50cc blood draw can only average a platelet dose of 2.9 Billion platelets (J. Magalon, see images). Including these 4 articles without recognizing or commenting that this PRP dose is low compared to other PRP systems in published literature is highly misleading. This prejudices the author's conclusion in a fatal way.
The remaining 2 articles used GPS 3 and Exactech respectively. The Dambrosi (2016) article that used GPS 3 reported injecting 16 cc of PRP from a 52 cc blood draw and a single 15 min. spin cycle. Even granting the benefit of the doubt since the authors did not test the PRP platelet count ....this could be the only study that delivered a PRP dose above 5 Billion. The Dong (2015) article that used the Exactech PRP kit did not even report the PRP volume injected....so there's that.....no help.
#3 In the very same Journal of Arthroscopy 3 years ago a well powered level 2 study using PRP for Cuff Tendinopathy was published with excellent PRP dosing data and follow-up. Dose? 5 Billion in a single injection. Outcome: 94% improvement by 6 months. Avg. return to sports 2.8 months. 93% needed just one injection. I understand that tendinopathy is not the same as a surgical cuff repair BUT the dosing here is clear and should be the starting point for PRP augmentation of cuff repairs.

The title of this just published paper needs to be changed to:
"Low or no dose PRP does not change outcomes of arthroscopic rotator cuff repair"
I would agree with that!