PRP has no significant effect on tendon-bone healing after ACL reconstruction
Heng Gong et al found in a prospective randomized controlled study that PRP had no significant effect on reducing bone tunnel widening, accelerating tendon-bone healing, or improving knee function; however, PRP may improve intra-articular graft (IAG) maturation.
60 patients with ruptured ACLs were divided one-to-one into two groups (study and control). Patients were treated using single-bundle autologous hamstring autografts. Only patients in the study group were administered PRP. Knee function (pre-operative and three-, six-, and 12-month post-operative Lysholm activity, Tegner and International Knee Documentation Committee scores, femoral tunnel (FT) and tibial tunnel (TT) diameters measured with computed tomography (post-operative follow-up at 4 days and at 12 months), and magnetic resonance imaging signal/noise quotients of the IAG and graft in the FT (at 12 months) were used to evaluate tendon–bone healing and graft maturation.
Before each patient's operation, 36 ml of peripheral blood was drawn from the patient's median cubital vein with 4 ml anticoagulant citrate dextrose solution A in a 50ml syringe. After fully mixing its contents, the barrel of the syringe was placed into a special centrifugal tube from the kit and performed the first centrifugation. Afterwards, the lower layer was removed, which comprised red blood cells, and performed centrifugation again on the upper layer, which comprised plasma. Finally, the platelet-poor top layer of plasma was discarded, and approximately 4 ml of PRP remained.
For patients in the study group, a 6-cm-long gelatin sponge filled with PRP was afixed in the centre of the four strands of tendon with 4–0 absorbable suture while preparing the graft,
• Patients' knee function scores improved after ACL reconstruction, but there were no significant differences between groups.
• At 12 months, FT (study, 8.88±1.46 mm; control, 8.42±2.75 mm) and TT (study, 9.50±1.07 mm; control, 9.99±1.91 mm) diameters were larger than FT (study, 6.91±0.74 mm; control, 7.30±1.17 mm) and TT (study, 9.31±0.83 mm; control, 9.36±0.88 mm) diameters at 4 days; however, differences between groups were not significant (FT, P=0.67; TT, P=0.52).
• There were no significant differences between groups for signal/noise quotients of the IAG (study, 1.38±0.70; control, 2.01±0.62; P=0.06) and FT-portion of the graft (study, 2.39±1.22; control, 2.46±0.83; P=0.89).
Further reading:
Clinical Use of Platelet Rich Plasma to Promote Tendon–Bone Healing and Graft Maturation in Anterior Cruciate Ligament Reconstruction—A Randomized Controlled Study
Heng Gong, Bin Huang et al
Indian Journal of Orthopaedics (2022) 56:805–811
https://doi.org/10.1007/s43465-021-00533-z
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