Aim: This study aimed to assess the effect of platelet-rich plasma (PRP) on anterior cruciate ligament (ACL) graft healing at graft tunnel interface and ACL graft 6 months post-reconstruction. Material & methods: A randomized trial involving 87 patients was conducted, dividing them into PRP and non-PRP groups. Magnetic resonance imaging (MRI) and functional outcome measures were used to evaluate graft healing. Results: Out of the 87 patients, 80 were analyzed. The PRP group exhibited superior clinical and radiological outcomes compared with the non-PRP group, as indicated by Figueroas score, Lysholm score and knee range of motion. Conclusion: These findings demonstrate that PRP can be used as an adjunct therapy for ACL reconstruction, enhancing graft healing and improving patient outcomes.

CTRI approval (Reg. No - CTRI/2018/11/016263)

Plain language summary

This study investigated the effects of platelet-rich plasma (PRP) on the healing of the anterior cruciate ligament (ACL) after knee reconstruction surgery. The ACL is an important ligament for knee stability, and its tear is a common sports injury. PRP, a substance found in blood, has been used to speed up healing in various surgeries. In this study, 80 patients who underwent ACL reconstruction were randomly assigned to receive either PRP or standard treatment. After 6 months, the group treated with PRP showed improved healing and better knee function compared with the non-PRP group. These findings suggest that PRP can help accelerate ACL healing and improve outcomes for patients.

Papers of special note have been highlighted as: • of interest

References

1. Sepulveda F, Sanchez L, Amy E, Micheo W. Anterior Cruciate Ligament Injury: Return to Play, Function and Long-Term Considerations. 16(3), 7 (2017).
Google Scholar
2. Kim HS, Seon JK, Jo AR. Current Trends in Anterior Cruciate Ligament Reconstruction. Knee Surg. Relat. Res. 25(4), 165–173 (2013).
MedlineGoogle Scholar
3. Janssen RPA, van der Wijk J, Fiedler A, Schmidt T, Sala HAGM, Scheffler SU. Remodelling of human hamstring autografts after anterior cruciate ligament reconstruction. Knee Surg. Sports Traumatol. Arthrosc. 19(8), 1299–1306 (2011).
MedlineGoogle Scholar
4. Dhillon M, Patel S, Shetty V, Behera P. Orthobiologics and platelet rich plasma. Indian J. Orthop. 48(1), 1 (2014).
MedlineGoogle Scholar
5. Lana JF, Huber SC, Purita J et al. Leukocyte-rich PRP versus leukocyte-poor PRP - The role of monocyte/macrophage function in the healing cascade. J. Clin. Orthopaedics and Trauma. 10, S7–S12 (2019).
MedlineGoogle Scholar
6. Vavken P, Sadoghi P, Murray MM. The effect of platelet concentrates on graft maturation and graft-bone interface healing in anterior cruciate ligament reconstruction in human patients: a systematic review of controlled trials. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 27(11), 1573–1583 (2011). • This review suggested that the addition of platelet concentrates to anterior cruciate ligament (ACL) reconstruction may have a beneficial effect on graft maturation.
MedlineGoogle Scholar
7. Ventura A, Terzaghi C, Borgo E, Verdoia C, Gallazzi M, Failoni S. Use of growth factors in ACL surgery: preliminary study. J. Orthopaed. Traumatol. 6(2), 76–79 (2005). • This CT-based study about use of growth factors for augmentation in ACL reconstruction reported positive outcomes in growth factor treated group.
Google Scholar
8. Orrego M, Larrain C, Rosales J et al. Effects of platelet concentrate and a bone plug on the healing of hamstring tendons in a bone tunnel. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 24(12), 1373–1380 (2008).
MedlineGoogle Scholar
9. Radice F, Yánez R, Gutiérrez 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: The Journal of Arthroscopic & Related Surgery. 26(1), 50–57 (2010).
MedlineGoogle Scholar
10. Valentí Nin JR, Mora Gasque G, Valentí Azcárate A, Aquerreta Beola JD, Hernandez Gonzalez M. Has Platelet-Rich Plasma Any Role in Anterior Cruciate Ligament Allograft Healing? Arthroscopy: The Journal of Arthroscopic & Related Surgery. 25(11), 1206–1213 (2009). • In the above study, authors did not find any substantial benefit from platelet-rich plasma (PRP) in patients treated with bone–patellar and tendon–bone allografts.
MedlineGoogle Scholar
11. Figueroa D, Melean P, Calvo R et al. Magnetic Resonance Imaging Evaluation of the Integration and Maturation of Semitendinosus-Gracilis Graft in Anterior Cruciate Ligament Reconstruction Using Autologous Platelet Concentrate. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 26(10), 1318–1325 (2010). • In this prospective comparative study authors reported did not find any statistically significant benefit in the APC group in terms of integration assessment and graft maturation, also authors proposed a scoring system to assess the ligamentization on MRI.
MedlineGoogle Scholar
12. Del Torto M, Enea D, Panfoli N, Filardo G, Pace N, Chiusaroli M. Hamstrings anterior cruciate ligament reconstruction with and without platelet rich fibrin matrix. Knee Surg. Sports Traumatol. Arthrosc. 23(12), 3614–3622 (2015).
MedlineGoogle Scholar
13. Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin. Orthop. (198), 43–49 (1985).
MedlineGoogle Scholar
14. Amiel D, Kleiner JB, Roux RD, Harwood FL, Akeson WH. The phenomenon of ?Ligamentization?: anterior cruciate ligament reconstruction with autogenous patellar tendon. J. Orthop. Res. 4(2), 162–172 (1986).
Medline CASGoogle Scholar
15. Wasserman A, Matthewson G, MacDonald P. Platelet-rich plasma and the knee–applications in orthopedic surgery. Curr. Rev. Musculoskelet. Med. 11(4), 607–615 (2018).
MedlineGoogle Scholar
16. Chen X, Jones IA, Park C, Vangsness CT. The Efficacy of Platelet-Rich Plasma on Tendon and Ligament Healing: A Systematic Review and Meta-analysis With Bias Assessment. Am. J. Sports Med. 46(8), 2020–2032 (2018).
MedlineGoogle Scholar
17. Azcárate AV, Lamo-Espinosa J, Beola JDA, Gonzalez MH, Gasque GM, Nin JRV. Comparison between two different platelet-rich plasma preparations and control applied during anterior cruciate ligament reconstruction. Is there any evidence to support their use? Injury 45, S36–S41 (2014).
Google Scholar
18. Chahla J, Cinque ME, Piuzzi NS et al. A Call for Standardization in Platelet-Rich Plasma Preparation Protocols and Composition Reporting: A Systematic Review of the Clinical Orthopaedic Literature. J. Bone Joint Surg. 99(20), 1769–1779 (2017). • The findings of this comprehensive review, which included 104 studies, emphasize the necessity for a thorough, precise, and step-by-step description of the PRP preparation protocol to ensure the reproducibility of results.
MedlineGoogle Scholar
19. Anitua E. Plasma rich in growth factors: preliminary results of use in the preparation of future sites for implants. Int. J. Oral Maxillofac. Implants 14(4), 529–535 (1999).
Medline CASGoogle Scholar
20. Dohan Ehrenfest DM, Rasmusson L, Albrektsson T. Classification of platelet concentrates: from pure platelet-rich plasma (P-PRP) to leucocyte- and platelet-rich fibrin (L-PRF). Trends Biotech. 27(3), 158–167 (2009).
MedlineGoogle Scholar
21. Moojen DJF, Everts PAM, Schure R-M et al. Antimicrobial activity of platelet-leukocyte gel againstStaphylococcus aureus. J. Orthop. Res. 26(3), 404–410 (2008).
MedlineGoogle Scholar
22. Weiler A, Peters G, Mäurer J, Unterhauser FN, Südkamp NP. Biomechanical Properties and Vascularity of an Anterior Cruciate Ligament Graft can be Predicted by Contrast-Enhanced Magnetic Resonance Imaging: A Two-Year Study in Sheep. Am J Sports Med. 29(6), 751–761 (2001).
Medline CASGoogle Scholar
23. Anderson K, Seneviratne AM, Izawa K, Atkinson BL, Potter HG, Rodeo SA. Augmentation of Tendon Healing in an Intraarticular Bone Tunnel with Use of a Bone Growth Factor. Am. J. Sports Med. 29(6), 689–698 (2001).
Medline CASGoogle Scholar
24. Silva A, Sampaio R. Anatomic ACL reconstruction: does the platelet-rich plasma accelerate tendon healing? Knee Surg. Sports Traumatol. Arthrosc. 17(6), 676–682 (2009).
MedlineGoogle Scholar
25. Vogrin M, Rupreht M, Dinevski D et al. Effects of a Platelet Gel on Early Graft Revascularization after Anterior Cruciate Ligament Reconstruction: A Prospective, Randomized, Double-Blind, Clinical Trial. Eur. Surg. Res. 45(2), 77–85 (2010).
Medline CASGoogle Scholar
26. Rupreht M, Jevtič V, Serša I, Vogrin M, Jevšek M. Evaluation of the tibial tunnel after intraoperatively administered platelet-rich plasma gel during anterior cruciate ligament reconstruction using diffusion weighted and dynamic contrast-enhanced MRI. J. Magn. Reson. Imaging 37(4), 928–935 (2013).
MedlineGoogle Scholar
27. Rupreht M, Vogrin M, Hussein M. MRI evaluation of tibial tunnel wall cortical bone formation after platelet-rich plasma applied during anterior cruciate ligament reconstruction. Radiol. Oncol. 47(2), 119–124 (2013).
MedlineGoogle Scholar
28. Briggs KK, Lysholm J, Tegner Y, Rodkey WG, Kocher MS, Steadman JR. The Reliability, Validity, and Responsiveness of the Lysholm Score and Tegner Activity Scale for Anterior Cruciate Ligament Injuries of the Knee: 25 Years Later. Am. J. Sports Med. 37(5), 890–897 (2009).
MedlineGoogle Scholar
29. Murray MM, Spindler KP, Ballard P, Welch TP, Zurakowski D, Nanney LB. Enhanced histologic repair in a central wound in the anterior cruciate ligament with a collagen–platelet-rich plasma scaffold. J. Orthop. Res. 25(8), 1007–1017 (2007).
Medline CASGoogle Scholar
30. Murray MM, Spindler KP, Abreu E et al. Collagen-platelet rich plasma hydrogel enhances primary repair of the porcine anterior cruciate ligament. J. Orthop. Res. 25(1), 81–91 (2007).
MedlineGoogle Scholar
31. Vogrin M, Rupreht M, Crnjac A, Dinevski D, Krajnc Z, Rečnik G. The effect of platelet-derived growth factors on knee stability after anterior cruciate ligament reconstruction: a prospective randomized clinical study. Wien Klin Wochenschr. 122(S2), 91–95 (2010). • In this prospective randomized clinical study authors found good outcomes in terms of ACL stability after ACL reconstruction
Medline CASGoogle Scholar
32. Zhu T, Zhou J, Hwang J, Xu X. Effects of Platelet-Rich Plasma on Clinical Outcomes After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis. Orthopaedic J. Sports Med. 10(1), 232596712110615 (2022).
Google Scholar
33. McRobb J, Kamil KH, Ahmed I, Dhaif F, Metcalfe A. Influence of platelet-rich plasma (PRP) analogues on healing and clinical outcomes following anterior cruciate ligament (ACL) reconstructive surgery: a systematic review. Eur. J. Orthop. Surg. Traumatol. 33(2), 225–253 (2022).
MedlineGoogle Scholar

Vol. 18, No. 8

Metrics

Downloaded 104 times

History

Received 7 June 2023

Accepted 6 July 2023

Published online 25 July 2023

Published in print August 2023

Information

Author contributions

K Munde – substantial contributions to the design of the work, analysis of the data for work, agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work. S Banerjee – substantial contributions to the conception, drafting the work, interpretation of data for the work; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. N Gahlot, A Elhence, S Mandal and T Yadav – substantial contributions to the conception, drafting the work, interpretation of data for the work; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The authors state that they have obtained appropriate institutional review board approval and have followed the principles outlined in the Declaration of Helsinki for all human experimental investigations. In addition, for investigations involving human subjects, informed consent has been obtained from the participants involved.

Data sharing statement

The authors certify that this manuscript reports original clinical trial data. Deidentified, individual data that underlie the results reported in this article (text, tables, figures and appendices), along with the study protocol will be available indefinitely for anyone who wants access to them.

PDF download