MRI evaluation of tibial tunnel wall cortical bone formation after platelet-rich plasma applied during anterior cruciate ligament reconstruction

Abstract

BackgroundAfter anterior cruciate ligament (ACL) reconstruction, formation of cortical sclerotic bone encircling the femoral and tibial tunnel is a part of intratunnel graft healing. During the physiological cascades of soft tissue healing and bone growth, cellular and hormonal factors play an important role. The purpose of this study was to non-invasively but quantitatively assess the effect of intraoperatively applied platelet-rich plasma (PRP) on the formation of cortical bone encircling the tibial tunnel.Patients and methodsIn fifty patients, standard arthroscopic ACL reconstructions were performed. The PRP group (n = 25) received a local application of PRP while the control group (n = 25) did not receive PRP. The proximal tibial tunnel was examined by MRI in the paraxial plane where the portion of the tibial tunnel wall circumference consisting of sclerotic cortical bone was assessed with testing occurring at one, two and a half and six months after surgery.ResultsAt one month after surgery, differences between the groups in the amount of cortical sclerotic bone encircling the tunnel were not significant (p = 0.928). At two and a half months, the sclerotic portion of the tunnel wall in the PRP group (36.2%) was significantly larger than in the control (22.5%) group (p = 0.004). At six months, the portion of sclerotic bone in the PRP group (67.1%) was also significantly larger than in the control (53.5%) group (p = 0.003).ConclusionsEnhanced cortical bone formation encircling the tibial tunnel at 2.5 and 6 months after ACL graft reconstruction results from locally applied platelet-rich plasma.

RETRACTED ARTICLE: Comparison of double-bundle anterior cruciate ligament reconstruction with and without autologous conditioned serum application

“…Biological signalling proteins are the driving force behind growing number of groups working on the use of platelet-rich plasma (PRP) as an adjunct treatment after surgery [19,29,34,35,40]. However, it is noteworthy that recent articles appear not to have found bone tunnel widening reduction with PRP [29,39].…”

Biological Treatments for Tendon and Ligament Abnormalities

“…After reconstruction, two biological responses occur: incorporation of the intra-articular ligamentous graft and healing within the bone tunnel 38,39 . A key limitation associated with ACL reconstruction is the lengthy recovery time associated with graft maturation, during which time patients are unable to return to athletic activity [40][41][42] .…”

“…We identified thirteen articles investigating the use of PRP as a surgical adjunct during ACL reconstruction 38,39,[41][42][43][44][45][46][47][48][49][50][51] , including nine RCTs 38,42-44,47-51 , one retrospective cohort study 46 , and three case-control studies 39,41,45 . A variety of different grafts were used, with eight studies involving the use of hamstring tendon as graft source, two involving the use of bone-tendon-bone (BTB) autograft, one involving the use of BTB allograft, one involving the use of tibialis allograft, and one involving the use of different graft types that were selected on the basis of patient characteristics.…”

“…The most commonly used outcome measure was graft maturation and incorporation into osseous tunnels as seen on MRI 38 We identified one study that investigated the use of autologous stem cells for ACL reconstruction 40 . In that study, Silva et al prospectively randomized forty-three patients to ACL reconstruction with or without stem cells.…”

Autogenic platelet-rich plasma: Types, activation methods, and applications

“…Badania te wykazały poprawę przebudowy i wgojenia się użytych wszczepów, co wykazano w tomografii komputerowej i rezonansie magnetycznym (5,25,26). Przeprowadzono doświadczenie u psów, gdzie wykonano uszkodzenie (ubytek) więzadła krzyżowego doczaszkowego (WKD), który następnie wypełniano kolagenem typu I połączonym z PRP.…”