Top

Journal of Orthopaedic Surgery and Research

Published in:

Open Access 01-12-2024 | Magnetic Resonance Imaging | Research article

Effect of bone marrow aspiration concentrate and platelet-rich plasma combination in anterior cruciate ligament reconstruction: a randomized, prospective, double-blinded study

Authors: Yu-Chuan Lin, Yu-Jen Chen, Tsang-Yu Fan, Pei-Hsi Chou, Cheng-Chang Lu

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2024

Abstract

Background

The effect of bone marrow aspirate concentrate (BMAC) and platelet-rich plasma (PRP) combination in enhancing graft maturation and tendon–bone tunnel interfacial healing after anterior cruciate ligament (ACL) reconstruction remains unclear. We hypothesised that BMAC and PRP combination could lead to better clinical results and better graft maturation/interface healing than PRP alone or conventional ACL reconstruction without any other biologic augmentation.

Methods

In this randomised double-blind prospective study, patients undergoing ACL reconstruction surgery were randomly assigned into three groups: (1) control group (without any biologic augmentation), (2) PRP treatment group, and (3) combined BMAC and PRP (BMAC + PRP) group. Moreover, they were evaluated using the clinical functional score, laxity examination, and magnetic resonance imaging (MRI) analysis.

Results

No significant difference was observed in the improvement of functional scores among groups. However, laxity improvement at 24 weeks showed a significant difference with the BMAC + PRP group having the lowest laxity. MRI analysis showed no significant change in whole graft maturation among groups. In particular, the BMAC + PRP group showed delayed signal peak and higher graft signal at 24 weeks compared with the other two groups; however, the difference was not significant. With regard to tendon–bone interfacial healing, the BMAC + PRP group showed significantly wider tendon–bone interface in the femoral bone tunnel at 24 weeks compared with the other two groups. Moreover, the BMAC + PRP group showed significantly higher peri-tunnel edema signal in the femoral bone tunnel at 12 weeks compared with the other two groups.

Conclusion

PRP alone and BMAC and PRP combination showed limited enhancing effect in clinical function, graft maturation and tendon–bone interfacial healing compared with control (no additional treatment). When BMAC is used in ACL reconstruction, the possibility of greater inflammation in the early stage to graft maturation and bone tunnel healing should be considered.

Bradley JP, Klimkiewicz JJ, Rytel MJ, Powell JW. Anterior cruciate ligament injuries in the National Football League: epidemiology and current treatment trends among team physicians. Arthroscopy. 2002;18(5):502–9. https://doi.org/10.1053/jars.2002.30649.CrossRefPubMed

Gianotti SM, Marshall SW, Hume PA, Bunt L. Incidence of anterior cruciate ligament injury and other knee ligament injuries: a national population-based study. J Sci Med Sport. 2009;12(6):622–7. https://doi.org/10.1016/j.jsams.2008.07.005.CrossRefPubMed

Sanders TL, Maradit Kremers H, Bryan AJ, Larson DR, Dahm DL, Levy BA, Stuart MJ, Krych AJ. Incidence of anterior cruciate ligament tears and reconstruction: a 21-year population-based study. Am J Sports Med. 2016;44(6):1502–7. https://doi.org/10.1177/0363546516629944.CrossRefPubMed

Herzog MM, Marshall SW, Lund JL, Pate V, Mack CD, Spang JT. Trends in incidence of ACL reconstruction and concomitant procedures among commercially insured individuals in the United States, 2002–2014. Sports Health. 2018;10(6):523–31. https://doi.org/10.1177/1941738118803616.CrossRefPubMedPubMedCentral

Marshall NE, Keller RA, Dines J, Bush-Joseph C, Limpisvasti O. Current practice: postoperative and return to play trends after ACL reconstruction by fellowship-trained sports surgeons. Musculoskelet Surg. 2019;103(1):55–61. https://doi.org/10.1007/s12306-018-0574-4.CrossRefPubMed

Janssen RP, Scheffler SU. Intra-articular remodelling of hamstring tendon grafts after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2014;22(9):2102–8. https://doi.org/10.1007/s00167-013-2634-5.CrossRefPubMed

Sato Y, Akagi R, Akatsu Y, Matsuura Y, Takahashi S, Yamaguchi S, Enomoto T, Nakagawa R, Hoshi H, Sasaki T, Kimura S, Ogawa Y, Sadamasu A, Ohtori S, Sasho T. The effect of femoral bone tunnel configuration on tendon-bone healing in an anterior cruciate ligament reconstruction: an animal study. Bone Jt Res. 2018;7(5):327–35. https://doi.org/10.1302/2046-3758.75.BJR-2017-0238.R2.CrossRef

Hexter AT, Hing KA, Haddad FS, Blunn G. Decellularized porcine xenograft for anterior cruciate ligament reconstruction: a histological study in sheep comparing cross-pin and cortical suspensory femoral fixation. Bone Jt Res. 2020;9(6):293–301. https://doi.org/10.1302/2046-3758.96.BJR-2020-0030.R2.CrossRef

Park MJ, Lee MC, Seong SC. A comparative study of the healing of tendon autograft and tendon-bone autograft using patellar tendon in rabbits. Int Orthop. 2001;25(1):35–9. https://doi.org/10.1007/s002640000199.CrossRefPubMedPubMedCentral

10.

Kanaya A, Deie M, Adachi N, Nishimori M, Yanada S, Ochi M. Intra-articular injection of mesenchymal stromal cells in partially torn anterior cruciate ligaments in a rat model. Arthroscopy. 2007;23(6):610–7. https://doi.org/10.1016/j.arthro.2007.01.013.CrossRefPubMed

11.

Centeno CJ, Pitts J, Al-Sayegh H, Freeman MD. Anterior cruciate ligament tears treated with percutaneous injection of autologous bone marrow nucleated cells: a case series. J Pain Res. 2015;31(8):437–47. https://doi.org/10.2147/JPR.S86244.CrossRef

12.

Anitua E, Andía I, Sanchez M, Azofra J, del Mar ZM, de la Fuente M, Nurden P, Nurden AT. Autologous preparations rich in growth factors promote proliferation and induce VEGF and HGF production by human tendon cells in culture. J Orthop Res. 2005;23(2):281–6. https://doi.org/10.1016/j.orthres.2004.08.015.CrossRefPubMed

13.

de Mos M, van der Windt AE, Jahr H, van Schie HT, Weinans H, Verhaar JA, van Osch GJ. Can platelet-rich plasma enhance tendon repair? A cell culture study. Am J Sports Med. 2008;36(6):1171–8. https://doi.org/10.1177/0363546508314430.CrossRefPubMed

14.

Gong H, Huang B, Zheng Z, Fu L, Chen L. Clinical use of platelet-rich plasma to promote tendon-bone healing and graft maturation in anterior cruciate ligament reconstruction-a randomized controlled study. Indian J Orthop. 2022;56(5):805–11. https://doi.org/10.1007/s43465-021-00533-z.CrossRefPubMedPubMedCentral

15.

Dallo I, Chahla J, Mitchell JJ, Pascual-Garrido C, Feagin JA, LaPrade RF. Biologic approaches for the treatment of partial tears of the anterior cruciate ligament: a current concepts review. Orthop J Sports Med. 2017;5(1):2325967116681724. https://doi.org/10.1177/2325967116681724.CrossRefPubMedPubMedCentral

16.

Xie X, Zhao S, Wu H, Xie G, Huangfu X, He Y, Zhao J. Platelet-rich plasma enhances autograft revascularization and reinnervation in a dog model of anterior cruciate ligament reconstruction. J Surg Res. 2013;183(1):214–22. https://doi.org/10.1016/j.jss.2013.01.020.CrossRefPubMed

17.

Zhang M, Zhen J, Zhang X, Yang Z, Zhang L, Hao D, Ren B. Effect of autologous platelet-rich plasma and gelatin sponge for tendon-to-bone healing after rabbit anterior cruciate ligament reconstruction. Arthroscopy. 2019;35(5):1486–97. https://doi.org/10.1016/j.arthro.2018.11.014.CrossRefPubMed

18.

Chen RJ, Zhu HZ, Gu XY, Xiang XX. Effects of platelet-rich plasma on tendon-bone healing after anterior cruciate ligament reconstruction. Orthop Surg. 2022;14(1):88–95. https://doi.org/10.1111/os.13175.CrossRefPubMed

19.

Zhao C, Chieh HF, Bakri K, Ikeda J, Sun YL, Moran SL, An KN, Amadio PC. The effects of bone marrow stromal cell transplants on tendon healing in vitro. Med Eng Phys. 2009;31(10):1271–5. https://doi.org/10.1016/j.medengphy.2009.08.004.CrossRefPubMedPubMedCentral

20.

Lu CC, Zhang T, Amadio PC, An KN, Moran SL, Gingery A, Zhao C. Lateral slit delivery of bone marrow stromal cells enhances regeneration in the decellularized allograft flexor tendon. J Orthop Translat. 2019;6(19):58–67. https://doi.org/10.1016/j.jot.2019.05.002.CrossRef

21.

Lu J, Chamberlain CS, Ji ML, Saether EE, Leiferman EM, Li WJ, Vanderby R. Tendon-to-bone healing in a rat extra-articular bone tunnel model: a comparison of fresh autologous bone marrow and bone marrow-derived mesenchymal stem cells. Am J Sports Med. 2019;47(11):2729–36. https://doi.org/10.1177/0363546519862284.CrossRefPubMed

22.

Wang Y, Han ZB, Song YP, Han ZC. Safety of mesenchymal stem cells for clinical application. Stem Cells Int. 2012;2012:652034. https://doi.org/10.1155/2012/652034.CrossRefPubMedPubMedCentral

23.

Seebach C, Henrich D, Schaible A, Relja B, Jugold M, Bönig H, Marzi I. Cell-based therapy by implanted human bone marrow-derived mononuclear cells improved bone healing of large bone defects in rats. Tissue Eng Part A. 2015;21(9–10):1565–78. https://doi.org/10.1089/ten.TEA.2014.0410.CrossRefPubMed

24.

Lu CC, Ho CJ, Huang HT, Lin SY, Chou SH, Chou PH, Ho ML, Tien YC. Effect of freshly isolated bone marrow mononuclear cells and cultured bone marrow stromal cells in graft cell repopulation and tendon-bone healing after allograft anterior cruciate ligament reconstruction. Int J Mol Sci. 2021;22(6):2791. https://doi.org/10.3390/ijms22062791.CrossRefPubMedPubMedCentral

25.

Centeno C, Markle J, Dodson E, Stemper I, Williams C, Hyzy M, Ichim T, Freeman M. Symptomatic anterior cruciate ligament tears treated with percutaneous injection of autologous bone marrow concentrate and platelet products: a non-controlled registry study. J Transl Med. 2018;16(1):246. https://doi.org/10.1186/s12967-018-1623-3.CrossRefPubMedPubMedCentral

26.

Anz AW, Plummer HA, Cohen A, Everts PA, Andrews JR, Hackel JG. Bone marrow aspirate concentrate is equivalent to platelet-rich plasma for the treatment of knee osteoarthritis at 2 years: a prospective randomized trial. Am J Sports Med. 2022;50(3):618–29. https://doi.org/10.1177/03635465211072554.CrossRefPubMed

27.

Haines CM, Bhatt FR, Orosz LD, Yamout T, Namian S, Bharara N, Bucci A, Schuler TC, Jazini E, Good CR. Low back pain, disability, and quality of life one year following intradiscal injection of autologous bone marrow aspirate concentrate. Stem Cells Int. 2022;12(2022):9617511. https://doi.org/10.1155/2022/9617511.CrossRef

28.

Fernandes G, Yang S. Application of platelet-rich plasma with stem cells in bone and periodontal tissue engineering. Bone Res. 2016;13(4):16036. https://doi.org/10.1038/boneres.2016.36.CrossRef

29.

Yin N, Wang Y, Ding L, Yuan J, Du L, Zhu Z, Pan M, Xue F, Xiao H. Platelet-rich plasma enhances the repair capacity of muscle-derived mesenchymal stem cells to large humeral bone defect in rabbits. Sci Rep. 2020;10(1):6771. https://doi.org/10.1038/s41598-020-63496-5.CrossRefPubMedPubMedCentral

30.

Teng C, Zhou C, Xu D, Bi F. Combination of platelet-rich plasma and bone marrow mesenchymal stem cells enhances tendon-bone healing in a rabbit model of anterior cruciate ligament reconstruction. J Orthop Surg Res. 2016;11(1):96. https://doi.org/10.1186/s13018-016-0433-7.CrossRefPubMedPubMedCentral

31.

Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res. 1985;198:43–9.CrossRef

32.

Hefti F, Müller W, Jakob RP, Stäubli HU. Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc. 1993;1(3–4):226–34. https://doi.org/10.1007/BF01560215.CrossRefPubMed

33.

Zhu T, Zhou J, Hwang J, Xu X. Effects of platelet-rich plasma on clinical outcomes after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Orthop J Sports Med. 2022;10(1):23259671211061536. https://doi.org/10.1177/23259671211061535.CrossRefPubMedPubMedCentral

34.

Zicaro JP, Garcia-Mansilla I, Zuain A, Yacuzzi C, Costa-Paz M. Has platelet-rich plasma any role in partial tears of the anterior cruciate ligament? Prospective comparative study. World J Orthop. 2021;12(6):423–32. https://doi.org/10.5312/wjo.v12.i6.423.CrossRefPubMedPubMedCentral

35.

Martin JR, Houdek MT, Sierra RJ. Use of concentrated bone marrow aspirate and platelet rich plasma during minimally invasive decompression of the femoral head in the treatment of osteonecrosis. Croat Med J. 2013;54(3):219–24. https://doi.org/10.3325/cmj.2013.54.219.CrossRefPubMedPubMedCentral

36.

Mazzotta A, Stagni C, Rocchi M, Rani N, Del Piccolo N, Filardo G, Dallari D. Bone marrow aspirate concentrate/platelet-rich fibrin augmentation accelerates healing of aseptic upper limb nonunions. J Orthop Traumatol. 2021;22(1):21. https://doi.org/10.1186/s10195-021-00582-y.CrossRefPubMedPubMedCentral

Title: Effect of bone marrow aspiration concentrate and platelet-rich plasma combination in anterior cruciate ligament reconstruction: a randomized, prospective, double-blinded study
Authors: Yu-Chuan Lin
Yu-Jen Chen
Tsang-Yu Fan
Pei-Hsi Chou
Cheng-Chang Lu
Publication date: 01-12-2024
Publisher: BioMed Central
Keywords: Magnetic Resonance Imaging
Magnetic Resonance Imaging
Edema
Published in: Journal of Orthopaedic Surgery and Research / Issue 1/2024
Electronic ISSN: 1749-799X
DOI: https://doi.org/10.1186/s13018-023-04512-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Effect of bone marrow aspiration concentrate and platelet-rich plasma combination in anterior cruciate ligament reconstruction: a randomized, prospective, double-blinded study

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2024

Clinical effect of full endoscopic lumbar annulus fibrosus suture

Overexpression of lncRNA LINC00665 inhibits the proliferation and chondroblast differentiation of bone marrow mesenchymal stem cells by targeting miR-214-3p

Correction: Lever sign test for anterior cruciate ligament injuries: a diagnostic meta-analysis

Opportunistic prediction of osteoporosis in patients with degenerative lumbar diseases: a simplified T12 vertebral bone quality approach

Effect of residual volume after surgery of the discoid lateral meniscus on tibiofemoral joint biomechanics: a finite element analysis

Compressive buttress compared with off-axial screw fixation for vertical femoral neck fractures in young adults: a prospective, randomized controlled trial