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Published in: Knee Surgery, Sports Traumatology, Arthroscopy 6/2009

01-06-2009 | Knee

Anatomic ACL reconstruction: does the platelet-rich plasma accelerate tendon healing?

Authors: Alcindo Silva, Ricardo Sampaio

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 6/2009

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Abstract

Recently, the use of hamstring tendons in anterior cruciate ligament repair has been increasing. However, tendon-to-bone healing occurs slowly, which can be a problem to an early return to sport activities. The use of growth factors from platelets seems to improve tissue healing. We enrolled 40 patients in a prospective study that were submitted to an anatomic reconstruction of the anterior cruciate ligament. Patients were sequentially enrolled into four groups: group A without platelet-rich plasma (PRP); group B with PRP in femoral tunnels at the end of surgery; group C with PRP in femoral tunnels at the end of surgery and intra-articular at 2- and 4 weeks after surgery; group D with PRP activated with thrombin in the femoral tunnels. All patients underwent magnetic resonance imaging of the knee 3 months after surgery to evaluate the signal intensity of the fibrous interzone (FIZ) in the femoral tunnels. We did not find any difference among the groups when comparing the signal intensity of the FIZ on magnetic resonance imaging.
Literature
1.
go back to reference Aglietti P, Buzzi R, D’Andria S et al (1993) Patellofemoral problems after intraarticular anterior cruciate ligament reconstruction. Clin Orthop 288:195–204PubMed Aglietti P, Buzzi R, D’Andria S et al (1993) Patellofemoral problems after intraarticular anterior cruciate ligament reconstruction. Clin Orthop 288:195–204PubMed
2.
go back to reference Anderson K, Seneviratne A, Izawa K, Atkinson B, Potter H, Rodeo S (2001) Augmentation of tendon healing in an intraarticular bone tunnel with use of a bone growth factor. Am J Sports Med 29:689–698PubMed Anderson K, Seneviratne A, Izawa K, Atkinson B, Potter H, Rodeo S (2001) Augmentation of tendon healing in an intraarticular bone tunnel with use of a bone growth factor. Am J Sports Med 29:689–698PubMed
3.
go back to reference Anitua E et al (2004) Autologous platelets as a source of proteins for healing and tissue regeneration. Thromb Haemost 91:4–15PubMed Anitua E et al (2004) Autologous platelets as a source of proteins for healing and tissue regeneration. Thromb Haemost 91:4–15PubMed
4.
go back to reference Benjamin M, Evans E, Copp D (1986) The histology of tendon attachments to bone in man. J Anat 149:89–100PubMed Benjamin M, Evans E, Copp D (1986) The histology of tendon attachments to bone in man. J Anat 149:89–100PubMed
5.
go back to reference Breitfuss H, Frohlich R, Povacz P et al (1996) The tendon defect after ACL reconstruction using the mid third patellar tendon: a problem for the patellofemoral joint? Knee Surg Sports Traumatol Arthrosc 24:196–198 Breitfuss H, Frohlich R, Povacz P et al (1996) The tendon defect after ACL reconstruction using the mid third patellar tendon: a problem for the patellofemoral joint? Knee Surg Sports Traumatol Arthrosc 24:196–198
6.
go back to reference Frick MA, Wenger DE, Adkins M (2007) MR imaging of synovial disorders of the knee: an update. Radiol Clin North Am 45(6):1017–1031PubMedCrossRef Frick MA, Wenger DE, Adkins M (2007) MR imaging of synovial disorders of the knee: an update. Radiol Clin North Am 45(6):1017–1031PubMedCrossRef
7.
go back to reference Fufa D, Shealy B, Jacobson M et al (2008) Activation of platelet-rich plasma using soluble type I collagen. J Oral Maxillofac Surg 66:684–690PubMedCrossRef Fufa D, Shealy B, Jacobson M et al (2008) Activation of platelet-rich plasma using soluble type I collagen. J Oral Maxillofac Surg 66:684–690PubMedCrossRef
8.
go back to reference Goradia V, Rochat M et al (2000) Tendon-to-bone healing of a semitendinosus tendon autograft used for ACL reconstruction in a sheep model. Am J Knee Surg 13:143–151PubMed Goradia V, Rochat M et al (2000) Tendon-to-bone healing of a semitendinosus tendon autograft used for ACL reconstruction in a sheep model. Am J Knee Surg 13:143–151PubMed
9.
go back to reference Liu S, Panossian V et al (1997) Morphology and matrix composition during early tendon to bone healing. Clin Orthop 339:253–260PubMedCrossRef Liu S, Panossian V et al (1997) Morphology and matrix composition during early tendon to bone healing. Clin Orthop 339:253–260PubMedCrossRef
10.
go back to reference Maeda A, Shino K, Horibe S et al (1996) Anterior Cruciate Ligament reconstruction with multistranded autogenous semitendinosus tendon. Am J Sports Med 24:504–509PubMedCrossRef Maeda A, Shino K, Horibe S et al (1996) Anterior Cruciate Ligament reconstruction with multistranded autogenous semitendinosus tendon. Am J Sports Med 24:504–509PubMedCrossRef
11.
go back to reference Marx RE et al (1998) Platelet-rich plasma: growth factor enhancement for bone grafts. Oral Surg Oral med Oral Pathol Oral Radiol Endod 85:638–646PubMedCrossRef Marx RE et al (1998) Platelet-rich plasma: growth factor enhancement for bone grafts. Oral Surg Oral med Oral Pathol Oral Radiol Endod 85:638–646PubMedCrossRef
12.
go back to reference May D, Disler D, Jones E, Balkissoon A, Manaster B. (2000) Abnormal signal intensity in skeletal muscle at MR imaging: patterns, pearls, and pitfalls. 20:S295–S315 May D, Disler D, Jones E, Balkissoon A, Manaster B. (2000) Abnormal signal intensity in skeletal muscle at MR imaging: patterns, pearls, and pitfalls. 20:S295–S315
13.
go back to reference Murray MM, Palmer M, Abreu E, Spindler KP, Zurakowski D, Fleming BC (2008) Platelet-rich plasma alone is not sufficient to enhance suture repair of the ACL in skeletally immature animals: an in vivo study (2008) J Orthop Res [Epub ahead of print] Murray MM, Palmer M, Abreu E, Spindler KP, Zurakowski D, Fleming BC (2008) Platelet-rich plasma alone is not sufficient to enhance suture repair of the ACL in skeletally immature animals: an in vivo study (2008) J Orthop Res [Epub ahead of print]
14.
go back to reference Murray MM, Spindler KP, Devin C et al (2006) Use of a collagen platelet rich plasma scaffold to stimulate healing of a central defect in the canine. ACLJ Orthop Res 24:820–830CrossRef Murray MM, Spindler KP, Devin C et al (2006) Use of a collagen platelet rich plasma scaffold to stimulate healing of a central defect in the canine. ACLJ Orthop Res 24:820–830CrossRef
15.
go back to reference Nebelung W, Becker R, Urbach D et al (2003) Histological findings of tendon-bone healing following anterior cruciate ligament reconstruction with hamstring grafts. Arch Orthop Trauma Surg 123:158–163PubMed Nebelung W, Becker R, Urbach D et al (2003) Histological findings of tendon-bone healing following anterior cruciate ligament reconstruction with hamstring grafts. Arch Orthop Trauma Surg 123:158–163PubMed
16.
go back to reference Otero A, Hutcheson L (1993) A comparison of the doubled semitendinosus/gracilis and central third of patellar tendon autografts in arthroscopic anterior cruciate ligament reconstruction. Arthroscopy 9:143–148PubMed Otero A, Hutcheson L (1993) A comparison of the doubled semitendinosus/gracilis and central third of patellar tendon autografts in arthroscopic anterior cruciate ligament reconstruction. Arthroscopy 9:143–148PubMed
17.
go back to reference Papageorgiou CD, Ma CB, Abramowitch SD et al (2001) A multidisciplinary study of the healing of an intraarticular anterior cruciate ligament graft in a goat model. Am J Sports Med. 29(5):620–626PubMed Papageorgiou CD, Ma CB, Abramowitch SD et al (2001) A multidisciplinary study of the healing of an intraarticular anterior cruciate ligament graft in a goat model. Am J Sports Med. 29(5):620–626PubMed
18.
go back to reference Peterson W, Laprell H (2000) Insertion of autologous tendon grafts to the bone. A histological of tendon and immunohistochemical study of hamstrings and patellar tendon grafts. Knee Surg Sports Traumatol Arthrosc 8:26–31CrossRef Peterson W, Laprell H (2000) Insertion of autologous tendon grafts to the bone. A histological of tendon and immunohistochemical study of hamstrings and patellar tendon grafts. Knee Surg Sports Traumatol Arthrosc 8:26–31CrossRef
19.
go back to reference Raghoebar GM et al (2005) Does platelet-rich plasma promote remodelling of autologous bone grafts used for the augmentation of the maxillary sinus floor? Clin Oral Implants Res16:359–356 Raghoebar GM et al (2005) Does platelet-rich plasma promote remodelling of autologous bone grafts used for the augmentation of the maxillary sinus floor? Clin Oral Implants Res16:359–356
20.
go back to reference Rodeo SA, Arnoczky SP, Torzilli PA, Hidaka C, Warren RF (1993) Tendon healing in a bone tunnel. A biomechanical and histological study in the dog. J Bone Joint Surg Am 75:1795–1803PubMed Rodeo SA, Arnoczky SP, Torzilli PA, Hidaka C, Warren RF (1993) Tendon healing in a bone tunnel. A biomechanical and histological study in the dog. J Bone Joint Surg Am 75:1795–1803PubMed
21.
22.
go back to reference Rosenberg J, Deffner K (1997) ACL reconstruction: semitendinosus tendon is the graft of choice. Orthopaedics 20:396–398 Rosenberg J, Deffner K (1997) ACL reconstruction: semitendinosus tendon is the graft of choice. Orthopaedics 20:396–398
23.
go back to reference Rubin D (2007) Magnetic resonance imaging: techniques and protocols tendons. In: Resnick (ed) Internal derangement of joints, 2nd edn. Saunders, Philadelphia, pp 40–41 Rubin D (2007) Magnetic resonance imaging: techniques and protocols tendons. In: Resnick (ed) Internal derangement of joints, 2nd edn. Saunders, Philadelphia, pp 40–41
24.
go back to reference Sampaio R et al (1995) Tumores dos Tecidos Moles em RM: correlação do hipossinal em T2 com as características microscópicas [MR imaging of Soft-Tissue Tumors: correlation of hipointensity in T2WI with histologic features]. Acta Radiol Portuguesa 8:23–28 Sampaio R et al (1995) Tumores dos Tecidos Moles em RM: correlação do hipossinal em T2 com as características microscópicas [MR imaging of Soft-Tissue Tumors: correlation of hipointensity in T2WI with histologic features]. Acta Radiol Portuguesa 8:23–28
25.
go back to reference Sharpey W, Ellis GV (1856) Elements of anatomy, vol 1, 6th edn. Walton and Moberly, London Sharpey W, Ellis GV (1856) Elements of anatomy, vol 1, 6th edn. Walton and Moberly, London
26.
go back to reference Wilson TC, Kantaras A, Atay A, Johnson DL (2004) Tunnel enlargement after anterior cruciate ligament surgery. Am J Sports Med 32:543–549PubMedCrossRef Wilson TC, Kantaras A, Atay A, Johnson DL (2004) Tunnel enlargement after anterior cruciate ligament surgery. Am J Sports Med 32:543–549PubMedCrossRef
27.
go back to reference Tomita F, Yasuda K, Mikami S et al (2001) Comparisons of intraosseous graft healing between the doubled flexor tendon graft and the bone-patellar tendon-bone graft in anterior cruciate ligamentreconstruction. Arthroscopy 17(5):461–476PubMedCrossRef Tomita F, Yasuda K, Mikami S et al (2001) Comparisons of intraosseous graft healing between the doubled flexor tendon graft and the bone-patellar tendon-bone graft in anterior cruciate ligamentreconstruction. Arthroscopy 17(5):461–476PubMedCrossRef
28.
go back to reference Ventura A, Terzaghi C, Borgo E, Vedoia C, Gallazi M, Failoni S (2005) Use of growth factors in ACL surgery: preliminary study. J Orthop Traumatol 6:76–79CrossRef Ventura A, Terzaghi C, Borgo E, Vedoia C, Gallazi M, Failoni S (2005) Use of growth factors in ACL surgery: preliminary study. J Orthop Traumatol 6:76–79CrossRef
29.
go back to reference Vogl T et al (2001) Reconstructed anterior cruciate ligaments using patellar tendon ligament grafts: diagnostic value of contrast-enhanced MRI in a 2-year follow-up regimen. Eur Radiol 11:1450–1456PubMedCrossRef Vogl T et al (2001) Reconstructed anterior cruciate ligaments using patellar tendon ligament grafts: diagnostic value of contrast-enhanced MRI in a 2-year follow-up regimen. Eur Radiol 11:1450–1456PubMedCrossRef
30.
go back to reference Weiler A, Peters G, Maurer J, Unterhauser FN, Sudkamp NP (2001) 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 29:751–761PubMed Weiler A, Peters G, Maurer J, Unterhauser FN, Sudkamp NP (2001) 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 29:751–761PubMed
31.
go back to reference Weiler A, Sckeffler S, Apreleva M (2006) Healing of ligaments and tendon to bone. In: Walsh W (ed) Repair and regeneration of ligaments, tendons, and joint capsule, 1st edn. Humana Press, New Jersey, pp 201–231 Weiler A, Sckeffler S, Apreleva M (2006) Healing of ligaments and tendon to bone. In: Walsh W (ed) Repair and regeneration of ligaments, tendons, and joint capsule, 1st edn. Humana Press, New Jersey, pp 201–231
32.
go back to reference Welsh WJ (2000) Autologous platelet gel-clinical function and usage in plastic surgery. Cosmetic Derm 13:13–18 Welsh WJ (2000) Autologous platelet gel-clinical function and usage in plastic surgery. Cosmetic Derm 13:13–18
33.
go back to reference Woo SL-Y, Suh J-K, Parsons IM et al (1998) Biologic intervention in ligament healing Sports. Med Arthrosc Rev 6:74–82 Woo SL-Y, Suh J-K, Parsons IM et al (1998) Biologic intervention in ligament healing Sports. Med Arthrosc Rev 6:74–82
Metadata
Title
Anatomic ACL reconstruction: does the platelet-rich plasma accelerate tendon healing?
Authors
Alcindo Silva
Ricardo Sampaio
Publication date
01-06-2009
Publisher
Springer-Verlag
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 6/2009
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-009-0762-8

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