Texture Analysis to Differentiate Anterior Cruciate Ligament in Patients After Surgery With Platelet-Rich Plasma

Abstract

BackgroundPlatelet-Rich Plasma (PRP) has been used to favor Anterior Cruciate Ligament (ACL) healing after reconstruction surgeries. However, clinical data are still inconclusive and subjective about PRP. Thus, we propose a quantitative method to demonstrate that PRP produced morphological structures changes.MethodsThirty-four patients undergoing ACL reconstruction surgery were evaluated and divided into Control Group (sixteen patients) without PRP application and Experiment Group (eighteen patients) with intraoperative application of PRP. Magnetic Resonance Imaging (MRI) scans were performed three months after surgery. We used Matlab® and Machine Learning (ML) in Orange Canvas® to Texture Analysis (TA) features extraction. Experienced radiologists delimited the regions of interest (RoIs) in the T2-weighted images. 62 texture parameters were extracted, including Gray-Level Co-occurrence Matrix and Gray Level Run Length. We used the algorithms Logistic Regression (LR), Naive Bayes (NB) and Stochastic Gradient Descent (SGD).ResultsThe accuracy of the classification with NB, LR, and SGD was 83.3%, 75%, 75%, respectively. For the area under the curve: NB, LR, and SGD presented values of 91.7%, 94.4%, 75%, respectively. In clinical evaluations, the groups show similar responses in terms of improvement in pain and increase in the IKDC index (International Knee Documentation Committee) and Lysholm Score indices differing only in the assessment of flexion, which presents a significant difference for the group treated with PRP.ConclusionsHere, we demonstrated quantitatively that patients who received PRP presented texture changes when compared to the control group. Thus, our findings suggest that PRP interferes with morphological parameters of the ACL.Trial RegistrationProtocol no. CAAE 56164316.6.0000.5411.

Effects of Platelet‐Rich Plasma on Tendon‐Bone Healing After Anterior Cruciate Ligament Reconstruction

“…According to Walters et al 27 , irrespective of whether they were randomized to receive PRP in their patellar defect or not, the patients continued to have similar levels of kneeling pain and patellar defect sizes after autograft bone-patellar tendon ACL reconstruction. However, Alves et al 28 demonstrated that patients who received PRP presented texture changes when compared to the normal saline group, and PRP interferes with the ACL morphological parameters. Despite some positive findings in graft maturation and clinical outcomes, further studies are needed to determine whether PRP contributes to tendon-bone healing in ACL reconstruction cases.…”