Title : Augmentation of tendon repair: A comparative review of Platelet-Rich Plasma (PRP) and Micro Fragmented Adipose Tissue (MFAT)
Abstract:
Tendon repair following surgical intervention presents a significant challenge due to the risk of incomplete healing, fibrosis, and re-injury. Platelet-rich plasma (PRP) is a well- studied intervention that contains evidence both supporting and discouraging its use in tendinopathies. Micro-fragmented adipose tissue (MFAT), containing adipose-derived mesenchymal stem cells and pericytes, may serve as an alternative to PRP for tendon injuries by promoting regeneration and mitigating inflammation-related complications. This review evaluates the efficacy of PRP and MFAT augmentations in Arthroscopic Rotator Cuff Repair (ARCR) and Achilles tendon treatments.
In ARCR, PRP reduced retear rates and short-term pain (VAS scores), particularly in tears greater than 2 cm and single-row repairs. Leukocyte-poor PRP (LP-PRP) also lowered retear rates and modestly improved functional outcomes (Constant, UCLA scores), but without clinically meaningful gains in other scales (ASES, Oxford). Other studies found PRP provided no advantage in ARCR, underscoring the need for standardized protocols. MFAT demonstrated short-term improvements in rotator cuff pain and function, especially when combined with structured exercises, though long-term benefits remain uncertain.
In Achilles tendon ruptures, PRP showed variable results, with notable short-to-mid-term improvements in muscle strength, ankle dorsiflexion, and reduced complication rates.
Conversely, several studies revealed limited or no clinical benefit of PRP compared to controls regarding functional outcomes, plantar flexion strength, pain relief, and quality- of-life metrics. Non-surgical treatments similarly indicated no meaningful advantages of PRP over placebo. PRP in chronic Achilles tendinopathy provided significant long-term improvements, though study limitations included small sample sizes and inconsistent preparation methods. MFAT augmentation demonstrated safety but lacked superior outcomes, despite individual reports of significant pain relief.
Early findings suggest combining MFAT and PRP could offer synergistic benefits for partial- thickness supraspinatus tears, warranting further research. Despite promising preliminary results, larger randomized trials and standardized methodologies are essential to clarify and optimize PRP and MFAT applications in tendon repair.
