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Platelet rich plasma use in allograft ACL reconstructions: Two-year clinical results of a MOON cohort study

Published:December 26, 2012DOI:https://doi.org/10.1016/j.knee.2012.12.001

      Abstract

      Background

      Platelet rich plasma has been promoted as a biologic agent to enhance tissue healing. As a concentration of autologous growth factors, it has gained increased use in musculoskeletal applications.

      Methods

      The purpose of this study was to evaluate the effect of intra-operative PRP on patient-reported outcomes 2 years after ACL reconstruction with tibialis anterior allograft. Fifty patients who underwent allograft ACL reconstruction with intra-operative application of PRP to the graft were matched with 50 allograft ACL -reconstructions without PRP use. The same surgeon performed all procedures with identical technique. Two year patient-reported outcomes including KOOS, IKDC, and Marx activity scores were obtained. Effusions in the immediate post-operative period, post-operative complications, and any subsequent procedures were also recorded.

      Results

      There was no difference between the groups with respect to additional surgeries or complications in the first 2 years after reconstruction. Decreased effusions at 10±4 days were noted in the PRP group, but this difference disappeared by 8±4 weeks. No differences in patient-reported outcomes were noted in the 58 patients with two-year outcome data.

      Conclusion

      The study demonstrated that although PRP application in tibialis allograft ACL reconstructions appeared safe; clinical benefit was minor and short-term. No differences in patient-reported outcomes or number of additional surgeries at 2 years were noted.

      Level of evidence

      Level III — retrospective comparative study.

      Keywords

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      References

        • Borchers J.R.
        • Pedroza A.
        • Kaeding C.
        Activity level and graft type as risk factors for anterior cruciate ligament graft failure: a case–control study.
        Am J Sports Med. 2009; 37: 2362-2367
        • Scheffler S.U.
        • Schmidt T.
        • Gangey I.
        • Dustmann M.
        • Unterhauser F.
        • Weiler A.
        Fresh-frozen free-tendon allografts versus autografts in anterior cruciate ligament reconstruction: delayed remodeling and inferior mechanical function during long-term healing in sheep.
        Arthroscopy. 2008; 24: 448-458
        • Dustmann M.
        • Schmidt T.
        • Gangey I.
        • Unterhauser F.N.
        • Weiler A.
        • Scheffler S.U.
        The extracellular remodeling of free-soft-tissue autografts and allografts for reconstruction of the anterior cruciate ligament: a comparison study in a sheep model.
        Knee Surg Sports Traumatol Arthrosc. 2008; 16: 360-369
        • Arnoczky S.P.
        • Caballero O.
        • Yeni Y.N.
        On the horizon from the ORS.
        J Am Acad Orthop Surg. 2010; 18: 445-448
        • Anitua E.
        • Andia I.
        • Sanchez M.
        • Azofra J.
        • del Mar Zalduendo M.
        • de la Fuente M.
        • et al.
        Autologous preparations rich in growth factors promote proliferation and induce VEGF and HGF production by human tendon cells in culture.
        J Orthop Res. 2005; 23: 281-286
        • Barry F.
        • Boynton R.E.
        • Liu B.
        • Murphy J.M.
        Chondrogenic differentiation of mesenchymal stem cells from bone marrow: differentiation-dependent gene expression of matrix components.
        Exp Cell Res. 2001; 268: 189-200
        • de Mos M.
        • van der Windt A.E.
        • Jahr H.
        • van Schie H.T.
        • Weinans H.
        • Verhaar J.A.
        • et al.
        Can platelet-rich plasma enhance tendon repair? A cell culture study.
        Am J Sports Med. 2008; 36: 1171-1178
        • Aspenberg P.
        • Virchenko O.
        Platelet concentrate injection improves Achilles tendon repair in rats.
        Acta Orthop Scand. 2004; 75: 93-99
        • Kajikawa Y.
        • Morihara T.
        • Sakamoto H.
        • Matsuda K.
        • Oshima Y.
        • Yoshida A.
        • et al.
        Platelet-rich plasma enhances the initial mobilization of circulation-derived cells for tendon healing.
        J Cell Physiol. 2008; 215: 837-845
        • Murray M.M.
        • Spindler K.P.
        • Abreu E.
        • Muller J.A.
        • Nedder A.
        • Kelly M.
        • et al.
        Collagen-platelet rich plasma hydrogel enhances primary repair of the porcine anterior cruciate ligament.
        J Orthop Res. 2007; 25: 81-91
        • Spindler K.P.
        • Murray M.M.
        • Carey J.L.
        • Zurakowski D.
        • Fleming B.C.
        The use of platelets to affect functional healing of an anterior cruciate ligament (ACL) autograft in a caprine ACL reconstruction model.
        J Orthop Res. 2009; 27: 631-638
        • Yasuda K.
        • Tomita F.
        • Yamazaki S.
        • Minami A.
        • Tohyama H.
        The effect of growth factors on biomechanical properties of the bone–patellar tendon–bone graft after anterior cruciate ligament reconstruction: a canine model study.
        Am J Sports Med. 2004; 32: 870-880
        • Radice F.
        • Yanez R.
        • Gutierrez V.
        • Rosales J.
        • Pinedo M.
        • Coda S.
        Comparison of magnetic resonance imaging findings in anterior cruciate ligament grafts with and without autologous platelet-derived growth factors.
        Arthroscopy. 2010; 26: 50-57
        • Everts P.A.
        • Devilee R.J.
        • Oosterbos C.J.
        • Mahoney C.B.
        • Schattenkerk M.E.
        • Knape J.T.
        • et al.
        Autologous platelet gel and fibrin sealant enhance the efficacy of total knee arthroplasty: improved range of motion, decreased length of stay and a reduced incidence of arthrofibrosis.
        Knee Surg Sports Traumatol Arthrosc. 2007; 15: 888-894
        • Gardner M.J.
        • Demetrakopoulos D.
        • Klepchick P.R.
        • Mooar P.A.
        The efficacy of autologous platelet gel in pain control and blood loss in total knee arthroplasty. An analysis of the haemoglobin, narcotic requirement and range of motion.
        Int Orthop. 2007; 31: 309-313
        • Lopez-Vidriero E.
        • Goulding K.A.
        • Simon D.A.
        • Sanchez M.
        • Johnson D.H.
        The use of platelet-rich plasma in arthroscopy and sports medicine: optimizing the healing environment.
        Arthroscopy. 2010; 26: 269-278
        • Zavadil D.P.
        • Satterlee C.C.
        • Costigan J.M.
        • Holt D.W.
        • Shostrom V.K.
        Autologous platelet gel and platelet-poor plasma reduce pain with total shoulder arthroplasty.
        J Extra Corpor Technol. 2007; 39: 177-182
        • Roos E.M.
        • Roos H.P.
        • Lohmander L.S.
        • Ekdahl C.
        • Beynnon B.D.
        Knee Injury and Osteoarthritis Outcome Score (KOOS)—development of a self-administered outcome measure.
        J Orthop Sports Phys Ther. 1998; 28: 88-96
        • Marx R.G.
        • Stump T.J.
        • Jones E.C.
        • Wickiewicz T.L.
        • Warren R.F.
        Development and evaluation of an activity rating scale for disorders of the knee.
        Am J Sports Med. 2001; 29: 213-218
        • Hefti F.
        • Muller W.
        • Jakob R.P.
        • Staubli H.U.
        Evaluation of knee ligament injuries with the IKDC form.
        Knee Surg Sports Traumatol Arthrosc. 1993; 1: 226-234
        • Nin J.R.
        • Gasque G.M.
        • Azcarate A.V.
        • Beola J.D.
        • Gonzalez M.H.
        Has platelet-rich plasma any role in anterior cruciate ligament allograft healing?.
        Arthroscopy. 2009; 25: 1206-1213
        • Silva A.
        • Sampaio R.
        Anatomic ACL reconstruction: does the platelet-rich plasma accelerate tendon healing?.
        Knee Surg Sports Traumatol Arthrosc. 2009; 17: 676-682
        • Ventura A.
        • Terzaghi C.
        • Borgo E.
        • Verdoia C.
        • Gallazzi M.
        • Failoni S.
        Use of growth factors in ACL surgery: preliminary study.
        J Orthop Traumatol. 2005; 6: 76-79
        • Vogrin M.
        • Rupreht M.
        • Crnjac A.
        • Dinevski D.
        • Krajnc Z.
        • Recnik G.
        The effect of platelet-derived growth factors on knee stability after anterior cruciate ligament reconstruction: a prospective randomized clinical study.
        Wien Klin Wochenschr. 2010; 122: 91-95