Platelet Rich Plasma Helps Heal Patellar Tendon Graft Site after ACL Surgery

In a prospective, randomized controlled trial, platelet rich plasma was found to improve patellar tendon graft site healing and decrease pain in the immediate post operative period.  See abstract below:

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TotalTendon

From the American Journal of Sports Medicine

Patellar Tendon Healing With Platelet-Rich Plasma: A Prospective Randomized Controlled Trial

1. Adriano Marques de Almeida, MD, MS (adrianoalmeida@usp.br),
2. Marco Kawamura Demange, MD, PhD, 
3. Marcel Faraco Sobrado,
4. Marcelo Bordalo Rodrigues, MD, 
5. André Pedrinelli, MD, PhD and
6. Arnaldo José Hernandez, MD, PhD

+Author Affiliations

1. Department of Orthopedics and Traumatology, São Paulo University Medical School, São Paulo, Brazil
2. Department of Orthopedics and Traumatology, São Paulo University Medical School, São Paulo, Brazil
3. São Paulo University Medical School, São Paulo, Brazil
4. Department of Orthopedics and Traumatology, São Paulo University Medical School, São Paulo, Brazil
5. Department of Orthopedics and Traumatology, São Paulo University Medical School, São Paulo, Brazil
6. Department of Orthopedics and Traumatology, São Paulo University Medical School, São Paulo, Brazil

Abstract

Background: The patellar tendon has limited ability to heal after harvesting its central third. Platelet-rich plasma (PRP) could improve patellar tendon healing.

Hypothesis: Adding PRP to the patellar tendon harvest site would improve donor site healing and improve clinical outcome at 6 months after anterior cruciate ligament (ACL) reconstruction with a patellar tendon graft.

Study Design: Randomized controlled trial; Level of evidence, 1.

Methods: Twenty-seven patients were randomly divided to receive (n = 12) or not receive (n = 15) PRP in the patellar tendon harvest site during ACL reconstruction. The primary outcome was magnetic resonance imaging (MRI) assessment of patellar tendon healing (gap area) after 6 months. Secondary outcomes were questionnaires and isokinetic testing of ACL reconstruction with a patellar tendon graft comparing both groups.

Results: Patellar tendon gap area was significantly smaller in the PRP group (4.9 ± 5.3 mm²; 95% confidence interval [CI], 1.1-8.8) than in the control group (9.4 ± 4.4 mm²; 95% CI, 6.6-12.2; P = .046). Visual analog scale score for pain was lower in the PRP group immediately postoperatively (3.8 ± 1.0; 95% CI, 3.18-4.49) than in the control group (5.1 ± 1.4; 95% CI, 4.24-5.90; P = .02). There were no differences after 6 months in questionnaire and isokinetic testing results comparing both groups.

Conclusion: We showed that PRP had a positive effect on patellar tendon harvest site healing on MRI after 6 months and also reduced pain in the immediate postoperative period. Questionnaire and isokinetic testing results were not different between the groups at 6 months.

Tennis Elbow PRP Discussion at ESSKA in Oslo, Norway

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Dr. Pietro Randelli moderated an excellent discussion of the treatment of tennis elbow (lateral epicondylitis) at the recent ESSKA meeting in Oslo, Norway.  Presentations about conservative care, platelet rich plasma injections and surgical treatment were given, including a debate about open versus arthroscopic techniques.  It is clear there are a variety of treatment options for this problem.  Platelet rich plasma is now considered a viable non-operative option.  Further data is presently being developed about the value of PRP vs surgery.  Stay tuned.

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Total Tendon
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Platelet Rich Plasma and ACL Surgery

The use of Platelet Rich Plasma to augment anterior cruciate ligament reconstruction has been much discussed but not well studied until now. In a prospective randomized trial, Nin et al studied allograft ACL surgery with and without PRP.

"We prospectively randomized 100 patients undergoing arthroscopic patellar tendon allograft ACL reconstruction to a group in whom platelet-enriched gel was used (n = 50) and a non-gel group (n = 50). The platelet concentration was 837 x 10(3)/mm(3), and the gel was introduced inside the graft and the tibial tunnel. The use of PDGF, on the graft and inside the tibial tunnel, in patients treated with bone-patellar tendon-bone allografts has no discernable clinical or biomechanical effect at 2 years' follow-up." Read Full Abstract

This is a good example of where PRP may NOT be helpful.

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Total Tendon