Platelet-Leukocyte Gel for Shoulder Impingement

Q: Have you ever heard of something called platelet-leukocyte gel? I saw an article in a magazine that said it is used to speed up healing after surgery. I'm having a decompression procedure for shoulder impingement. Is it something I should ask the surgeon about?

A: Platelet-leukocyte gel is a substance containing of a mixture of platelet-rich plasma (PRP), white blood cells (leukocytes), and thrombin (for blood clotting). It is taken from the patient's own blood and applied to the surgical site.

It can also be added to autologous bone (taken from the patient) to create a biologically active bone graft when bone graft is called for in a procedure. This is not usually the case in a decompression procedure for shoulder impingement. In any case, platelet-leukocyte gel when applied after shoulder decompression works because the thrombin will activate the platelet-rich plamsa (PRP). This means the platelets release growth factors that can indeed help speed up healing and recovery.

These growth factors increase the production of collagen (the building blocks of soft tissues) while at the same time improving repair of the wound site. The platelet-leukocyte gel even has antimicrobial effects that help prevent infection.

Platelet-leukocyte gel is not something that is used routinely. More surgeons in Europe have started using it compared with U.S. surgeons. But it use is on the rise in the United States. There is evidence that an increasing number of clinicians are using platelet-leukocyte gel applications in various surgical settings and for different types of procedures.

You can certainly ask your surgeon about this but don't be surprised if he or she is not using it yet. Studies so far show moderate evidence for the effectiveness of this product for patients recovering from shoulder decompression surgery.

More research is really needed before it would ever be adopted routinely by all surgeons. It's possible the product works better for some procedures (or even for some people) than for others. Scientific study could identify factors that could predict success or failure to help guide surgeons in deciding when and with whom to use this treatment.

Reference: Lukas Gebremariam, MD, et al. Effectiveness of Surgical and Postsurgical Interventions for the Subacromial Impingement Syndrome: A Systematic Review. In Archives of Physical Medicine and Rehabilitation. November 2011. Vol. 92. No. 11. Pp. 1900-1913.