Double-looped semitendinosus and gracilis tendon autograft. Fixation: 2 bioabsorbable cross-pins in the femoral tunnel and one bioabsorbable interference screw in the tibial tunnel.
After autograft positioning into the femoral and tibial tunnels (1 mL in each of them), and onto the graft itself (3 mL) without arthroscopic fluid.
6 m
A gradual increase in the percentage of the tunnel wall consisting of tunnel wall cortical bone (TCB) during the followup was observed. At six months the mean percentage of TCB was significantly higher () in the PRP group than in the control group.
Clinical, CT, and arthrometric evaluation of PRP role in prevention of tunnel widening after ACL reconstruction
46 (23 versus 23) Age: 26.4 versus 26.9 Sex: 20 M—3 F versus 22 M—1 F
Preparation method: Double syringe system (Arthrex) Platelet count: — Activation method: none Leukocyte: few
Single-bundle quadrupled autograft of hamstrings. Fixation: a cross-pin in the femoral tunnel and a bioabsorbable interference screw in the tibial tunnel
Graft immersed in the PRP solution for five minutes before implantation; 2 mL of PRP injected into the femoral tunnel and 1.5 mL into the tibial tunnel at the end of the surgery.
3 m
Despite slightly less tunnel widening in the PRP group, there were no significant differences at any of the sites of measurement between immediately after surgery and three months postoperatively.
Retrospective comparative study (PRP versus control)
Evaluation of the effect of intraoperative PRP on patient-reported clinical outcomes
58 (29 versus 29) Age: 35.1 versus 35.3 Sex: —
Preparation method: GPS II Platelet Concentrate Separation Kit (Biomet, Inc., Warsaw, IN, USA) Platelet count: — Activation method: calcium chloride Leukocyte: Y?
Allograft tibial tendon. Fixation: an absorbable cross-pin in the femoral tunnel and an absorbable interference screw in the tibial tunnel
After graft positioning intra-articular portion of the graft was coated with PRP.
24 m
Decreased effusions at days were noted in the PRP group, but this difference disappeared by weeks. No differences in patient-reported outcomes were noted in the 58 patients with two-year outcome data.
Double-looped semitendinosus and gracilis tendon autograft. Fixation: 2 bioabsorbable cross-pins in the femoral tunnel and one bioabsorbable interference screw in the tibial tunnel.
Applied after autograft positioning, into the femoral and tibial tunnels (1 mL in each of them), as well as onto the graft itself (3 mL) without arthroscopic fluid
6 m
DWI and DCE-MRI measurements indicate a reduced extent of edema during the first postoperative month as well as an increased vascular density and microvessel permeability in the proximal tibial tunnel at 1 and 2.5 postoperative months as the effect of the application of PRPG.
CT evaluation of the efficacy of platelet-rich plasma (PRP) in reducing femoral and tibial tunnel enlargement and clinical score
40 (20 versus 20) Age: 34.5 Sex: 40 M
Preparation method: PRP Fast Biotech kit (MyCells PPT-Platelet Preparation Tube). Platelet count: — Activation method: addition of thrombin and 10% Ca-gluconate Leukocyte: Y?
ACL reconstruction with hamstrings (Out-In technique). Fixation: Swing-Bridge device on the femoral side and Evolgate screw on the tibial side.
(i) 5 mL of PRP between the peripheral part of the graft and the femoral tunnel wall; (ii) 5 mL of PRP in its semisolid pattern above the graft; (iii) 5 mL of liquid and semisolid PRP on the tibial side.
14.7 m
The use of PRP does not seem to be effective in preventing tunnel enlargement. Physical examination as well as the evaluation scales used showed no differences between the two groups.
MRI evaluation of healing of patellar tendon harvest site
27 (12 versus 15) Age: 25.8 versus 23.1 Sex: 10 M—2 F versus 14 M—1 F
Preparation method: Haemonetics MCS1 9000 cell separator with a specific kit for platelet apheresis 995-E (Haemonetics Corp, Braintree, Massachusetts) Platelet count: 1,185,166/mm3 ± 404,472/mm3 Activation method: thrombin and 0.8 mL of calcium chloride Leukocyte: 0.91/mm3 ± 0.81/mm3
Autologous bone-patellar tendon-bone graft. Fixation: absorbable transverse double pin system in the femur and an absorbable interference screw in the tibia.
The patellar tendon defect was completely filled with 20 to 40 mL of PRP gel and the peritendon was closed with absorbable 3–0 sutures.
6 m
Patellar tendon gap area was significantly smaller ( 0.046) in the PRP group ( mm2) than in the control group ( mm2). Visual analog scale score for pain was lower in the PRP group immediately postoperatively () than in the control group (). There were no differences after 6 months in questionnaire and isokinetic testing results comparing both groups.
MRI and clinical evaluation of healing of patellar tendon harvest site
40 (20 versus 20) Age: 22.9 versus 22.7 Sex: 40 M
Preparation method: the Gravitational Platelet Separation II (GPS) system (Biomet Biologics, Inc., Warsaw, IN, USA) Platelet count: — Activation method: thrombin and calcium chloride Leukocyte: Y?
PRP was applied to both the patellar and tendon-bone plug harvest site and stabilized by peritendon suture
12 m
VISA scores were significantly higher in the patients treated with PRP, whereas no significant difference in postoperative VAS scores between the two groups was observed. In 85% of PRP group patients, the tibial and patellar bone defect was satisfactorily filled by new bony tissue, whereas this percentage was just of 60% in control group patients, but this difference was not statistically significant.
MRI evaluation of the revascularization process in the osteoligamentous interface zone in the bone tunnels and in the intra-articular part of the graft after ACL reconstruction
41 (21 versus 20) Age: 37.2 versus 32.6 Sex: 13 M—8 F versus 15 M—5 F
Preparation method: Magellan (Medtronic Biologic Therapeutics and Diagnostics, Minneapolis, MN, USA) Platelet count: /L Activation method: autologous human thrombin Leukocyte: present (?)
Double-looped semitendinosus and gracilis tendon graft. Fixation: 2 bioabsorbable cross-pins in the femoral tunnel and 1 bioabsorbable interference screw in the tibial tunnel.
PRP was applied into the femoral and tibial tunnels as well as onto the graft itself.
4–6 weeks
After 4–6 weeks, the PRP-treated group demonstrated a significantly higher level of vascularization in the osteoligamentous interface () than in the control group (; ). In the intra-articular part of the graft, we found no evidence of revascularization in either group.
MRI evaluation of integration and maturation of semitendinosus-gracilis (STG) grafts in anterior cruciate ligament (ACL)
50 (30 versus 20) Age: 26.8 versus 23.6 Sex: 18 M—12 F versus 15 M—5 F
Preparation method: Magellan system (Medtronic, Minneapolis, MN) Platelet count: — Activation method: autologous human thrombin Leukocyte: Y
ACL reconstruction with hamstring tendons (ST-G). Fixation: a cross-pin in the femoral tunnel and a bioabsorbable interference screw in the tibial tunnel.
PRP was applied under arthroscopy in both the tibial (3 mL) and femoral (3 mL) tunnels with a long needle syringe and directly applied in the intra-articular graft portion (4 mL)
6 m
No statistically significant benefit in the PRP group in terms of integration assessment and graft maturation (ligamentization).
Macroscopic and histologic evaluation of ligamentization of tendon grafts
37 (22 versus 15) Age: 28 Sex: 26 M—11 F
Preparation method: BTI System II (BTI Biotechnology Institute, Vitoria, Spain) Platelet count: 2- to 3-fold the platelet count of peripheral blood Activation method: calcium chloride Leukocyte: scarce leukocytes
ACL reconstruction with hamstring tendons. Fixation: transcondylar screw proximally and PRGF-treated bone plug and 2 metal staples distally.
Six mL PRP was injected within the tendon graft fascicles with several punctures performed along the graft length, graft soaked in PRP until implantation and the remaining aliquots were applied at the portals during suturing.
15 m
Overall, arthroscopic evaluations were not statistically different between PRGF and control groups (). PRGF treatment influenced the histologic characteristics of the tendon graft, resulting in tissue that was more mature than in controls (). Histologically evident newly formed connective tissue enveloping the graft was present in 77.3% of PRGF-treated grafts and 40% of controls.
MRI evaluation of PRPG effect on cell proliferation and collagen production in the human tendon and plays a key role in the remodeling and repair processes of the graft used in ACL reconstruction.
50 (25 versus 25) Age: 30 versus 32 Sex: 18 M—7 F versus 21 M—4 F
Preparation method: GPS system of Biomet (Warsaw, IN) Platelet count: — Activation method: calcium chloride Leukocyte: Y?
BPTB autograft (15 versus 10) or hamstring (10 versus 15). Fixation: in BPTB autograft metallic interference screws; in hamstring autograft metallic or bioabsorbable cross-pin in the distal femur; and a bioabsorbable screw with a metallic staple in the proximal tibia.
PRP administered with the help of a sutured and compressed Gelfoam; 5 mL PRP was added homogeneously so as to completely cover the graft.
9 versus 12 m
ACL reconstruction with the use of PRPG achieves complete homogeneous grafts assessed by MRI, in 179 days compared with 369 days for ACL reconstruction without PRPG. This represents a time shortening of 48% with respect to ACL reconstruction without PRPG.
To evaluate and compare the clinical and inflammatory parameters with the addition of platelet-derived growth factor (PDGF) in primary anterior cruciate ligament (ACL) reconstruction with bone-patellar tendon-bone allograft.
100 (50 versus 50) Age: 26.1 versus 26.6 Sex: 40 M—10 F versus 38 M—12 F
Preparation method: 40 mL of citrated blood was centrifuged for 8 minutes at 3,000 rpm (2,217 g) by use of a standard centrifuge Platelet count: /mm3 Activation method: 10% calcium chloride Leukocyte: present (?)
ACL reconstruction with patellar tendon allograft. Fixation: 2 biodegradable cross-pins in the femoral bone and a tibial biodegradable interference screw.
Ligament covered with PRP and sutured over itself with PRP in its interior. The rest of the gel was introduced after implantation of the graft inside the tibial tunnel.
18 m
The results did not show any statistically significant differences between the groups for inflammatory parameters, magnetic resonance imaging appearance of the graft, and clinical evaluation scores.
Randomized trial (4 groups: group A control; group B PRP in FT; group C with PRP in FT and intra-articular at 2 and 4 weeks; group D with PRP activated with thrombin in FT)
To assess with magnetic resonance (MR) imaging if the PRP accelerates tendon-to-bone integration in the femoral tunnel (FT) after hamstring double-bundle ACL reconstruction.
40 (10 versus 10 versus 10 versus 10) Age: 26.8 Sex: 38 M—2 F
Preparation method: Mini GPS III Kit (Biomet) Platelet count: — Activation method: calcium chloride Leukocyte: Y?
Double-bundle arthroscopic ACL reconstruction with autologous hamstring tendons. Fixation: 2 Endobutton for the AM and PL bundle in the femur, 2 bioabsorbable interference screw in the tibia.
PRP was placed between the strands of the graft in each femoral tunnel.
3 m
The graft integration is not complete at 3 months after surgery in the PL and AM femoral tunnel, using Endobutton CL for fixation, and the use of PRP isolated or with thrombin seems not to accelerate tendon integration
Randomized trial (lesser quality, 4 groups: control, PC, BP, and PC + BP)
Determine if the use of platelet concentrate (PC) and bone plug (BP) does accelerate the healing process in anterior cruciate ligament (ACL) reconstruction, in terms of maturation of the graft, osteoligamentous interface, and widening of the femoral tunnel.
108 (27 versus 26 versus 28 versus 27) Age: 30 Sex: 99 M—17 F (−8 dropout)
ACL reconstruction with quadruple STG. Fixation: a biodegradable transfixing pin proximally and a biodegradable interference screw distally; the bone plug was placed by interference fit at the level of the femoral tunnel.
Five mL PRP was added between the strands of the quadruple STG graft before passing into the tunnel. After fixation, 1 mL of PRP was injected into the femoral tunnel between the strands of the graft.
6 m
The use of PC had an enhancing effect on the graft maturation process evaluated only by MRI signal intensity, without showing any significant effect in the osteoligamentous interface or tunnel widening evolution. The use of a BP effectively prevented tunnel widening. The BP and PC combination did not show a synergic effect as compared to PC or BP individually.
