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.
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References
Aglietti P, Buzzi R, D’Andria S et al (1993) Patellofemoral problems after intraarticular anterior cruciate ligament reconstruction. Clin Orthop 288:195–204
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 29:689–698
Anitua E et al (2004) Autologous platelets as a source of proteins for healing and tissue regeneration. Thromb Haemost 91:4–15
Benjamin M, Evans E, Copp D (1986) The histology of tendon attachments to bone in man. J Anat 149:89–100
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
Frick MA, Wenger DE, Adkins M (2007) MR imaging of synovial disorders of the knee: an update. Radiol Clin North Am 45(6):1017–1031
Fufa D, Shealy B, Jacobson M et al (2008) Activation of platelet-rich plasma using soluble type I collagen. J Oral Maxillofac Surg 66:684–690
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 13:143–151
Liu S, Panossian V et al (1997) Morphology and matrix composition during early tendon to bone healing. Clin Orthop 339:253–260
Maeda A, Shino K, Horibe S et al (1996) Anterior Cruciate Ligament reconstruction with multistranded autogenous semitendinosus tendon. Am J Sports Med 24:504–509
Marx RE et al (1998) Platelet-rich plasma: growth factor enhancement for bone grafts. Oral Surg Oral med Oral Pathol Oral Radiol Endod 85:638–646
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
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, 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 24:820–830
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 123:158–163
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 9:143–148
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):620–626
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 8:26–31
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
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 75:1795–1803
Rodeo S, Izawa K (1999) Tendon to bone healing. Tech Orthop 14:22–33
Rosenberg J, Deffner K (1997) ACL reconstruction: semitendinosus tendon is the graft of choice. Orthopaedics 20:396–398
Rubin D (2007) Magnetic resonance imaging: techniques and protocols tendons. In: Resnick (ed) Internal derangement of joints, 2nd edn. Saunders, Philadelphia, pp 40–41
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
Sharpey W, Ellis GV (1856) Elements of anatomy, vol 1, 6th edn. Walton and Moberly, London
Wilson TC, Kantaras A, Atay A, Johnson DL (2004) Tunnel enlargement after anterior cruciate ligament surgery. Am J Sports Med 32:543–549
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):461–476
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 6:76–79
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 11:1450–1456
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 29:751–761
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
Welsh WJ (2000) Autologous platelet gel-clinical function and usage in plastic surgery. Cosmetic Derm 13:13–18
Woo SL-Y, Suh J-K, Parsons IM et al (1998) Biologic intervention in ligament healing Sports. Med Arthrosc Rev 6:74–82
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Silva, A., Sampaio, R. Anatomic ACL reconstruction: does the platelet-rich plasma accelerate tendon healing?. Knee Surg Sports Traumatol Arthrosc 17, 676–682 (2009). https://doi.org/10.1007/s00167-009-0762-8
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DOI: https://doi.org/10.1007/s00167-009-0762-8