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Knee Surg Sports Traumatol Arthrosc (2009) 17:676682 DOI 10.1007/s00167-009-0762-8
KNEE
Anatomic ACL reconstruction: does the platelet-rich plasma accelerate tendon healing?
Alcindo Silva Ricardo Sampaio
Received: 2 October 2008 / Accepted: 18 February 2009 / Published online: 14 March 2009 Springer-Verlag 2009
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 brous interzone (FIZ) in the femoral tunnels. We did not nd any difference among the groups when comparing the signal intensity of the FIZ on magnetic resonance imaging.
Keywords Anterior cruciate ligament
Anatomic reconstruction Platelet-rich plasma
Prospective randomized study
Introduction
One of the challenges of anterior cruciate ligament (ACL) reconstruction is to achieve secure graft attachment between the tendon and bone to allow early range of motion and activity. The most commonly used grafts in this procedure are autologous bone-patellar, hamstrings, and quadriceps tendons. The main healing process leading to bone integration occurs in the bone tunnel and depends on the type of graft and xation mechanism [17, 26, 27]. Autologous bone-patellar tendon-bone graft offers the strongest healing potential because it relies mainly on bone-to-bone integration between the graft bone plug and the tunnel wall [17, 27]. However, bone-patellar tendon-bone has some donor-site morbidity and leads some surgeons to search for alternative graft sources. Autologous hamstring grafts have less donor-site morbidity but, regarding bone integration, rely solely on tendon-to-bone healing. This process occurs slowly leading to concerns about graft pullout and slippage resulting in joint instability and potential failure of the graft.
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