Background: The increasing incidence of anterior cruciate ligament (ACL) and meniscal injuries has led to strong interest in discovering new methods to enhance the biological healing response of these tissues. Platelet-rich plasma (PRP) contains various growth factors associated with a positive healing response, but few existing clinical studies are available to determine the risks and benefits of these therapies. Purpose: To determine the effects of intraoperative PRP on postoperative knee function and complications at 2 years after ACL reconstruction with meniscal repair. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective matched case-control study was conducted between 2013 and 2017 using a single surgeon database of 1014 patients undergoing primary ACL reconstruction with concomitant meniscal repair, resulting in 324 patients (162 PRP patients and 162 control patients) who met the study criteria. Patients were matched by age, sex, graft type, and meniscal injury. The Single Assessment Numeric Evaluation (SANE) was administered at 2 years, and injury surveillance was conducted. Secondary outcomes included the time to return to activity (months), self-reported knee function (International Knee Documentation Committee [IKDC] score), functional performance testing (knee range of motion, single-leg balance, single-leg hopping, agility testing), and postoperative complications (graft failure, infection, loss of motion [requiring repeat arthroscopy for lysis of adhesions], venous thrombosis, etc). Univariate models were used for between-group comparisons, and alpha was set at .05 for all analyses. Results: No differences were found in SANE knee function scores between the PRP and matched-control groups at 2 years (91.6 ± 11.2 vs 92.4 ± 10.6, respectively; P = .599). Additionally, no differences were reported between groups for self-reported function (IKDC score, 87.6 ± 13.3 vs 88.1 ± 12.6; P = .952), functional performance testing ( P > .05), and timing of return to activity (7.8 ± 1.9 vs 8.0 ± 1.9 months; P = .765). The PRP group demonstrated a higher rate of postoperative knee motion loss compared with the control group (13.6% vs 4.6%; P < .001). No other differences were observed in postoperative complications ( P > .05). Conclusion: The added use of intraoperative PRP did not improve self-reported knee function, functional performance, and timing of return to activity for patients undergoing ACL reconstruction with meniscal repair. Furthermore, the use of PRP may have negative consequences for regaining knee range of motion after surgery. On the basis of these data, surgeons should cautiously consider the application of PRP when planning surgery for intra-articular injuries of the knee. Registration: NCT03704376 ( ClinicalTrials.gov identifier).
BackgroundDespite the association between hip abduction weakness and non-contact anterior cruciate ligament (ACL) injury, hip abduction strength is rarely considered in return to sport decision-making following ACL reconstruction (ACLR).
Background: Rates of return to preinjury level of play after anterior cruciate ligament (ACL) reconstruction (ACLR) remain unsatisfactory, particularly for patients who undergo revision surgery. Psychological readiness is associated with successful return to sport (RTS) and self-perceived preinjury sport performance. Purpose: To compare psychological readiness at RTS between patients who underwent revision ACL autograft reconstruction and matched controls who underwent primary ACL autograft reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: Data were gathered using a single orthopaedic surgeon database of patients who underwent ACLR between 2015 and 2018. Patients who underwent revision ACLR and met the study criteria (N = 92) were matched by age, sex, graft type, and rehabilitation protocol to a control group of patients who underwent primary ACLR (n = 92). Functional assessment at release to play was examined using passive knee range of motion, single-leg squat, and single-leg hop testing. Self-reported outcomes included the International Knee Documentation Committee subjective function survey and the ACL–Return to Sport after Injury (ACL-RSI) psychological readiness scale. Time to release to play was recorded as the number of months needed to reach a ≥90% limb symmetry index from the date of the index ACLR. Data were assessed for normality using the Shapiro-Wilk test, and univariate general linear models were utilized with an alpha level of .05. Results: The overall mean patient age was 29.9 ± 10 years, and 40% of patients were women. No significant differences between groups were noted in any of the baseline patient characteristics or surgical findings. At RTS, the mean ACL-RSI score was significantly lower in the revision surgery group (77.4 ± 19.4 vs 85.3 ± 17.4; P = .011). In addition, the revision surgery group returned to play significantly later than the primary surgery group (9.4 ± 2 vs 8.1 ± 1.3 months, respectively; P < .001). Conclusion: When compared with primary ACL autograft reconstruction, revision reconstruction patients exhibited lower psychological readiness scores and a longer time to meet the objective criteria for RTS. Registration: NCT03704376 ( ClinicalTrials.gov identifier).
Background: Subchondral bone injuries, or bone bruises, are commonly observed on magnetic resonance imaging (MRI) after anterior cruciate ligament (ACL) injury. The current relationship between bone bruise volume and postsurgical outcomes remains poorly understood. Purpose: To examine the influence of bone bruise volume on self-reported and objective functional outcomes at the time of return to play and 2 years following ACL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: Clinical, surgical, and demographic data were obtained for a sample of convenience utilizing a single-surgeon ACL database (n = 1396). For 60 participants, femoral and tibial bone bruise volumes were estimated from preoperative MRI. Data obtained at the time of return to play included International Knee Documentation Committee (IKDC-2000) score, ACL–Return to Sport after Injury (ACL-RSI) score, and performance on an objective functional performance battery. Two-year follow-up data included graft reinjury rate, level of return to sport/activity, and self-reported knee function using the Single Assessment Numeric Evaluation (SANE). The forward stepwise linear regression was used to determine the relationship between bone bruise volume and patient function. Results: The distribution of bone bruise injuries was as follows: lateral femoral condyle (76.7%), lateral tibial plateau (88.3%), medial femoral condyle (21.7%), and medial tibial plateau (26.7%). Mean total bone bruise volume of all compartments was 7065.7 ± 6226.6 mm3. At the 2-year follow up, there were no significant associations between total bone bruise volume and time of return to play ( P = .832), IKDC-2000 score ( P = .200), ACL-RSI score ( P = .370), or SANE score ( P = .179). Conclusion: The lateral tibial plateau was the most frequent site to sustain bone bruise injury. Preoperative bone bruise volume was not associated with delayed time to return to sport or self-reported outcomes at time of return to play or at 2 years postoperatively. Registration: NCT03704376 ( ClinicalTrials.gov identifier).
Objectives: The frequent injury and compromised healing of intra-articular structures (i.e. cruciate ligaments and menisci) has led to an intense interest among surgeons and scientists for discovering new methods of enhancing the biological healing response of these tissues. Platelet-rich-plasma (PRP) contains various growth factors that positively effect biological healing, unfortunately few existing clinical studies are available to determine the risks and benefits of these therapies. Therefore, the purpose of this study was to determine the influence of intraoperative PRP on postoperative knee function and complications out to 2-years following ACL reconstruction with meniscus repair. Methods: A matched case-control study was conducted using a single surgeon database of 673 patients undergoing ACL reconstruction with concomitant meniscus repair (Figure 1) resulting in 324 patients [PRP (n = 162) vs matched-control (n = 162)] who met the study criteria. Patients were matched on age, gender, graft type, and meniscus tear size and location. The single assessment numeric evaluation (SANE) was administered at 2-years and served as the primary outcome measure. Secondary outcomes included the time to return-to-activity (mo), self-reported knee function [International Knee Disability Committee (IKDC)], objective functional testing (knee ROM, single-leg balance, single leg-hopping, agility testing), and postoperative complications (graft failure, infection, loss of motion, venous thrombosis, etc). Univariate models were used for between groups comparisons and alpha was set at .05 for all analyses. Results: There were no differences in SANE knee function scores between the PRP and matched-control groups at 2-years, respectively (91.6 ±11.2 vs 92.4 ±10.6, P = .599). Additionally, no differences were observed between groups for self-reported function (IKDC score; 87.6 ±13.3 vs 88.1 ±12.6, P = .952), objective functional testing (P > .05), and timing of return-to-activity (7.8 ±1.9 vs 8.0 ±1.9, P = .765). The PRP group demonstrated a higher rate of postoperative knee motion loss complications when compared to the control group (13.5% vs 4.9%, P < .001). No other differences were observed in postoperative complications (P > .05). Conclusion: The added use of intraoperative PRP did not improve self-reported knee function, objective functional testing, and timing of return-to-activity for patients undergoing ACL reconstruction with concomitant meniscus repair. Furthermore, the use of PRP may have negative consequences for regaining knee ROM after surgery. Based on these data, surgeons should cautiously consider the application of PRP when surgical planning for intra-articular injuries of the knee.
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