Injection of Leukocyte‐Poor Platelet‐Rich Plasma During Rotator Cuff Repair Can Increase Healing Rate but Does Not Affect Clinical Outcomes: A Systematic Review and Meta‐analysis of Randomized Controlled Trials

Purpose To evaluate the efficacy of injected leukocyte‐poor platelet‐rich plasma (LP‐PRP) during arthroscopic rotator cuff repair, primarily in reducing failure rates and, secondarily, in improving shoulder function and clinical outcome. Methods A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Review and Meta‐Analysis guidelines. Medline/PubMed, Scopus, Web of Science, and Cochrane databases were searched up to August 31, 2025, for comparative studies investigating the injectable LP‐PRP during arthroscopic rotator cuff repair. Inclusion criteria were Level I or II studies reporting clinical and radiological outcomes with more than 6‐month follow‐up. Data were extracted on failure incidence and patient‐reported outcome measures. Quantitative synthesis was performed using inverse variance weighting, and heterogeneity was assessed with the I 2 statistic. Results Five randomized controlled trials (n = 470 patients; 235 LP‐PRP, 235 control) were included. No difference was found in mean age ( P = .760) and gender distribution ( P = >.99) between the 2 study groups. Repair failure occurred in 34/213 (15.9%) in the LP‐PRP group versus 63/217 (29.0%) in controls (odds ratio 2.16; 95% confidence interval 1.34‐3.48; P = .001; relative risk 0.55; 95% confidence interval 0.38‐0.79). The LP‐PRP group showed greater improvements in Constant score at 6 months (31.6 vs 28.4; P = .001), 12 months (46.9 vs 44.2; P = .001), and 24 months (45.7 vs 42.8; P = .003), Single Assessment Numeric Evaluation at 12 months (42 vs 38.7; P = .036), University of California‐Los Angeles at 6, 12, and 24 months ( P < .001 for all), and visual analog scale at 3 months (5.9 vs 4.6; P = .001) and 24 months (5.2 vs 4.9; P = .012); nevertheless, none of these improvements reached the minimal clinically important difference. Complication rates were comparable between groups (9.4% vs 7.7%; P = .508). Conclusions Injection of LP‐PRP during rotator cuff repair appears to be a safe procedure that may increase the healing rate. However, it has not been associated with improvements in patient‐reported outcome measures sufficient to reach the minimal clinically important difference. Level of Evidence Level II, systematic review of Level I and II randomized controlled trials.