Results of subacromial surgery;
The influence of growth factors (PDGF), applied as autologous trombocyte concentrate, on functional recovery

Subacromial surgery of the shoulder is performed often. It concerns space
creating interventions (open and arthroscopic subacromial decompression) and
rotator cuff surgery (open and arthroscopic).
In this kind of surgery good wound healing and tissue recovery is of great
importance to achieve optimal results. Wound healing disorders, pain and the
formation of adhesions may negatively influnce the postoperative course and
lead to extended rehabilitation. This has an infavourable influence on the
personal well being of the patient and the possibility to return to labour.
Especially in cuff surgery the course is strongly influenced by the healing of
the attachment of the cuff to the bone.
Besides the development of minimal invasive techniques, it's necessary to look
for possibilities to decrease the morbidity of these procedures.
Recent studies show that growth factors play a major role in wound healing.
This concerns particularly TFG-B (transforming growth factor B) and PDGF
(platelet derived growth factor) present in thrombocytes. They act as
chemotactic agents for polymorphnuclear leucocytes, macrophages, fibroblasts
and lymphocytes.
Both growth factors stimulate the wound healing and cause improved angiogenesis
and fibroplasie. They also play a role in wound retraction and remodelling.
In animal-experimental models it is proved that the apllication of TGF-B and
PDGF improves woundhealing and leads to better mechanical properties of the
scar tissue.
Faster and better wound healing and decreased development of adhesions after
subacromial surgery can possibly be influenced favourably by using thrombocyte
concentrate. In the treatment with autologous thrombocyte concentrate a
thrombocyte rich concentrate is obtained by a centrifuging method
(Gravitational Platelet System (GPS), Biomet, Warsaw USA) (platelet rich plasma
or PRP), that can be applied in the operating field. The concentrate is harvest
from the patients own blood, sampled during the procedure.
At random the concentrated is apllicated and both groups are compared
postoperatively.

test the hypothesis that the application of PRP leads to faster wound healing,
less wound healing disorders, less pain and faster functional recovery after
subacromial surgery.

1. inclusion of the patients
2. informed consent
3. 0- measurement by preoperative score
4. randomization in the operating room
group A = application of the thrombocyte concentratein the subacromial
space after wound closure
group B = control group, no application

Operative method:
- general anesthesia / regional block
- blood sampling and preparation with sterile GPS kit
- open or arthroscopic subacromial decompression
- subacromial application of the thrombocyte concntrate after skin closure (no
drain is left)
- antirotating sling

The thrombocyte concentrate is obtained by taking of 55 ml of blood of the
patient during schoulder surgery. With the GPS system the blood is centrifuged.
After that the Platelet Rich Plasma (PRP) is stored in a sterile way. After
wound closure the PRP is applicated in the subacromial space and the wound is
covered.
Further treatment is identical for both groups.
control takes places on day 1 postoperatively and 2, 6, and 12 weeks
postoperatively. Patients are scored on pain (VAS), mobility, ADL function
(simple shoulder test), UCLA score, SF36(RAND) and Constant Murley score.

The application of autologous trombocyte concentrate (PRP). This is a
concentrate with a high amount of trombocytes (containing growth factors),
obtained by centrifuging the paient's own blood. The concentrate is applied
into the subacromial space after closure.

With every visit the patient is asked to fill in a questionnaire.
As far as studied, the risks are no different than the risks of the surgery