P-061 - (Poster #61) The Role of PRP and MFAT in Enhancing Rotator Cuff Healing: Evidence from Recent Clinical Studies

Background: Arthroscopic rotator cuff repair (ARCR), along with many other invasive tendon repair procedures, presents a significant challenge in rehabilitation due to the risk of incomplete healing, fibrosis, and re-injury. Platelet-rich plasma (PRP) injections have gained attention as a biologic method to enhance tendon healing, with evidence both supporting and discouraging its use in tendinopathies and tears. However, some evidence has shown that while PRP reduces retear rates radiologically, it doesn't significantly improve clinical outcomes like pain and function. Additionally, dosages and concentrations are inconsistent between studies. Micro-fragmented Adipose Tissue (MFAT) injections are less widely used than PRP injections and involve harvesting small amounts of a patient’s adipose tissue, microfragmenting and cleaning the tissue, and injecting the resulting composite consisting primarily of mesenchymal stem cells (MSCs) and pericytes into the site of injury to promote regeneration. MFAT is a possible alternative to PRP injections for augmentation with ARCR with evidence that MFAT creates a beneficial microenvironment for tendon healing to avoid long term complications related to fibrosis and inflammation. 

Purpose/Objectives: This literature review aims to outline the current evidence regarding the use of PRP and MFAT injections in optimizing rehabilitation from arthroscopic rotator cuff repair. Optimization will first be achieved by identifying clinically significant standardized dosage parameters for MFAT and PRP administration through quantitative volumetric analysis of graft composition and platelet concentrations. This review was also done in order to characterize MFAT’s long-term clinical outcomes without the use of surgery by using validated functional metrics and pain severity scores, including Constant-Murley Score and Visual Analog Scale (VAS), respectively. By establishing MFAT’s durability in structural tendon healing and symptom modulation, this research seeks to address existing evidence gaps in long-term biologic efficacy while providing protocol standardization for PRP/MFAT combinations. Additionally, findings will create a foundational framework for investigating MFAT’s potential in augmenting other tendon repair procedures, including Achilles and patellar tendon reconstructions, through comparative mechanotransduction and cellular proliferation analyses.


Methods: A systematic literature review was conducted using databases including PubMed, Embase, Web of Science, and the Cochrane Library for studies published up to June 2025. Search terms included combinations of “micro-fragmented adipose tissue,” “MFAT,” “platelet-rich plasma,” “PRP,” “rotator cuff repair,” “arthroscopy,” and “clinical outcomes.”

Inclusion criteria were randomized controlled trials, comparative cohort studies, meta-analyses, or case reports up to 10 years old at the time of this publication involving adults (≥18 years) with full-thickness rotator cuff tears undergoing primary ARCR, with at least 1 month of follow-up and reporting pain or functional outcomes (VAS, NPS, or Constant-Murley scores). Excluded were animal or non-peer-reviewed studies, studies with partial-thickness or irreparable tears requiring grafts, revision surgeries, prior biologic injections within 12 months, patients with comorbidities impairing healing (e.g., infection, autoimmune arthritis, uncontrolled diabetes, chronic steroid use), and interventions lacking standardized processing protocols or involving mixed biologics. Additionally, meta-analyses that contained studies with varying heterogeneity of PRP/MFAT administration were excluded.

Statistical analyses were performed using SPSS, with heterogeneity assessed via I² statistics and significance set at p < 0.05. 


Results: PRP: 

Leukocyte-rich and leukocyte-poor platelet-rich plasma (LR-PRP and LP-PRP, respectively), as well as platelet-rich fibrin (PRF), were prepared from autologous blood and injected intraoperatively during ARCR in multiple studies. Compared to controls, PRP (regardless of leukocyte content) significantly reduced retear rates as confirmed by imaging modalities, including ultrasound (US) and MRI, with retear incidences ranging from 8.6% to 16.5% in PRP groups versus 23.6% to 28.6% in controls (P values < .05 in most studies). PRP recipients also demonstrated modest but statistically significant improvements in CM scores (mean differences: +1.98 to +2.56; P < .05) and lower VAS pain scores, particularly in the short term (WMD: –0.63; 95% CI: –0.83 to –0.43; P < .001). However, pure PRP (P-PRP) injected between the tendon-bone footprint and bursal side did not significantly affect imaging outcomes, CM scores, or VAS pain scores at 1-year follow-up. Early postoperative pain, as indicated by VAS scores, was consistently lower in PRP groups, but long-term functional outcomes, as indicated by CM, UCLA, and DASH scores, showed only small, clinically modest differences compared to controls.



MFAT:

Ultrasound-guided injection of MFAT into supraspinatus tendon tears has shown promising results, with a single-patient case reporting CM score improvement from 63 to 93 and VAS pain reduction from 7/10 to 1/10 at 8 weeks, alongside MRI evidence of enhanced tendon integrity. In case series, MFAT treatment for chronic rotator cuff pathology led to significant VAS score reductions (p < 0.001), and in full-thickness tears, emulsified, enzyme-free MFAT (mean 1.5 mL) improved VAS (5.9 to 2.5, p = 0.003) and CM (52.6 to 71.2, p = 0.003) scores at 3 months, though MRI at 6 months showed only partial tendon improvement. Another study using similar MFAT methodology reported significant NPS pain reduction (7.94 to 3.7, p < 0.0001) at 12 months, but lacked post-treatment imaging data. In ARCR, MFAT augmentation did not alter VAS scores or retear rates, but increased CM scores at 6 months (82.78 vs 76.66; P = .0050). Adipose-derived MSCs in fibrin glue improved pain and function, with MRI showing lower retear rates (14.3% vs 28.5%) compared to controls

Conclusions/Implications for future research and/or clinical care: Current evidence suggests that both PRP and MFAT are safe modalities in the augmentation of ARCR. PRP, particularly when injected intraoperatively, was associated with modest but statistically significant improvements in CM scores and VAS pain scores, and a substantial reduction in retear rates confirmed by imaging. However, these functional gains were generally small and tended to converge with controls by mid- to long-term follow-up.

MFAT augmentation for rotator cuff pathologies managed non-surgically shows meaningful potential in improving pain levels and functional outcomes. However, controlled studies indicate that MFAT does not significantly impact pain, tendon integrity, or retear rates compared to standard ARCR, aside from modest gains in functional scores at 6 months. The addition of adipose-derived MSCs may further reduce retear rates, although overall clinical outcomes remain comparable to controls.  

Further studies should aim to investigate the long-term effects of both treatments, namely with follow-ups that exceed 2 years. Additionally, there is a need for randomized controlled trials directly comparing the effects of PRP and MFAT augmentation on pain levels, function, and patient satisfaction. Overall, the evidence suggests that MFAT is a potential alternative for PRP, but the literature remains inconclusive due to limited studies.