Injury, Int. J. Care Injured 45SX (2014) SX–SX
Introduction
The rest period required following surgical treatment of
rupture of the anterior cruciate ligament (ACL) is often very
long. Different methods have been evaluated in an attempt to
shorten the time required for the graft to acquire biomechanical
properties similar to those of the original ACL [1].
ACL reconstruction with grafts is usually successful and
predictable [2]. Various aspects of reconstruction, such as graft
options, tunnel placement, tensioning and fixation techniques,
are being revised repeatedly to improve the results. Nevertheless,
the healing process of ligament and tendon is extremely complex
and not fully understood [3-7]. Platelet-rich plasma (PRP)
has been recognised as a powerful adhesive and haemostatic
agent and a potent source of autologous growth factors [8-12].
Consequently, there has been strong clinical interest in the use
of PRP as an aid in tissue regeneration.
The use of PRP treatment has become more widespread in
sports medicine [3,5,13-16], mainly because of the advantage of
using the patient’s own growth factors, and ease of preparation
[3,5]. Some studies in ACL reconstruction have reported
favourable clinical outcomes using different PRP treatments
[16-18], whereas others found no advantages [19-21].
There is insufficient scientific evidence from current research
to prove the safety and effectiveness of PRP treatment [1]. Most
of the published research comprises case reports or case-series
studies that have no control group or that have insufficient
sample sizes to enable calculation of statistical significance:
more research is needed using randomised double-blind
methods [5,22,23].
We hypothesised that PRP may improve the outcome of ACL
reconstruction by enabling better graft remodelling, immediate
KEYWORDS
Platelet-rich plasma
Anterior cruciate ligament reconstruction
Graft maturation
ABSTRACT
Introduction: To compare the clinical, analytical and graft maturation effects of two different platelet-
rich plasma (PRP) preparations applied during anterior cruciate ligament (ACL) reconstruction.
Materials and methods: A total of 150 patients with ACL disruption were included in the study.
Arthroscopic ACL reconstruction with patellar tendon allograft was conducted on all knees using
the same protocol. One hundred patients were prospectively randomised to either a group to receive
double-spinning platelet-enriched gel (PRP) with leukocytes (n=50) or to a non-gel group (n=50).
Finally, we included 50 patients treated with a platelet-rich preparation from a single-spinning
procedure (PRGF Endoret
®
Technology) without leukocytes.
Inflammatory parameters, including C-reactive protein (CRP) and knee perimeters (PER), were
measured 24 hours and 10 days after surgery. Postoperative pain score (visual analogue score [VAS])
was recorded the day after surgery. Follow-up visits occurred postoperatively at 3, 6, and 12 months.
The International Knee Documentation Committee scale (IKDC) was included to compare functional
state, and MRI was conducted 6 months after surgery.
Results: The PRGF group showed a statistically significant improvement in swelling and inflammatory
parameters compared with the other two groups at 24 hours after surgery (p<0.05).
The results did not show any significant differences between groups for MRI and clinical scores.
Conclusions: PRGF used in ACL allograft reconstruction was associated with reduced swelling; however,
the intensity and uniformity of the graft on MRI were similar in the three groups, and there was no
clinical or pain improvement compared with the control group.
Level of Evidence: II
© 2014 Elsevier Ltd. All rights reserved.
Comparison between two different platelet-rich plasma preparations and
control applied during anterior cruciate ligament reconstruction. Is there any
evidence to support their use?
A. Valentí Azcáratea
a,
*, J Lamo-Espinosa
a
, D Aquerreta
b
, M Hernandez
c
, G Mora
a
, JRValentí Nin
a
a
Orthopedic Surgery and Traumatology Department, Clínica Universidad de Navarra, Pamplona, Spain
b
Radiologic Department, Clínica Universidad de Navarra, Pamplona, Spain
c
Haematology Department, Clínica Universidad de Navarra, Pamplona, Spain
* Corresponding author at: Orthopedic Surgery and Traumatology, Clínica
Universidad de Navarra, Av. Pio XII, 36. 31008 Pamplona Spain. Tel.: +34 948 255
400; fax: + 34 948 296 500.
E-mail address: avalazc@gmail.com (A. Valentí Azcáratea).
0020-1383/$ – see front matter © 2014 Elsevier Ltd. All rights reserved.
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