Sánchez Mikel, Anitua Eduardo, Azofra Juan, Andía Isabel, Padilla Sabino, Mujika Iñigo
Arthroscopic Surgery Unit, USP-La Esperanza Clinic, Basque Country, Spain.
Am J Sports Med. 2007 Feb;35(2):245-51. doi: 10.1177/0363546506294078. Epub 2006 Nov 12.
Platelet-rich fibrin matrices release a natural mixture of growth factors that play central roles in the complex processes of tendon healing.
Application of autologous platelet-rich matrices during Achilles tendon surgery may promote healing and functional recovery.
Case-control study and descriptive laboratory study; Level of evidence, 3.
Twelve athletes underwent open suture repair after complete Achilles tendon tear. Open suture repair in conjunction with a preparation rich in growth factors (PRGF) was performed in 6 athletes and retrospectively compared with a matched group that followed conventional surgical procedure. The outcomes were evaluated on the basis of range of motion, functional recovery, and complications. Achilles tendons were examined by ultrasound at 50 +/- 11 months in retrospective controls and 32 +/- 10 months in the PRGF group. In the laboratory portion of the study, PRGF treatment was characterized by the number of platelets and concentration of insulin (IGF-I), transformed (TGF-beta1), platelet-derived (PDGF-AB), vascular endothelial (VEGF), hepatocyte (HGF), and epidermal (EGF) growth factors in patients affected by musculoskeletal traumatic injuries.
Athletes receiving PRGF recovered their range of motion earlier (7 +/- 2 weeks vs 11 +/- 3 weeks, P = .025), showed no wound complication, and took less time to take up gentle running (11 +/- 1 weeks vs 18 +/- 3 weeks, P = .042) and to resume training activities (14 +/- 0.8 weeks vs 21 +/- 3 weeks, P = .004). The cross-sectional area of the PRGF-treated tendons increased less (t = 3.44, P = .009). TGF-beta1 (74.99 +/- 32.84 ng/mL), PDGF-AB (35.62 +/- 14.57 ng/mL), VEGF (383.9 +/- 374.9 pg/mL), EGF (481.5 +/- 187.5 pg/mL), and HGF (593.87 +/- 155.76 pg/mL) significantly correlated with the number of platelets (677 +/- 217 platelets/microL, P < .05).
The operative management of tendons combined with the application of autologous PRGF may present new possibilities for enhanced healing and functional recovery. This needs to be evaluated in a randomized clinical trial.
富含血小板的纤维蛋白基质可释放天然的生长因子混合物，这些生长因子在肌腱愈合的复杂过程中发挥核心作用。
在跟腱手术中应用自体富含血小板的基质可能促进愈合和功能恢复。
病例对照研究和描述性实验室研究；证据等级，3级。
12名运动员在跟腱完全断裂后接受了开放缝合修复。6名运动员在开放缝合修复的同时应用了富含生长因子的制剂（PRGF），并与采用传统手术方法的匹配组进行回顾性比较。根据活动范围、功能恢复情况和并发症对结果进行评估。对回顾性对照组的跟腱在50±11个月时进行超声检查，对PRGF组的跟腱在32±10个月时进行超声检查。在研究的实验室部分，通过受肌肉骨骼创伤性损伤患者的血小板数量以及胰岛素（IGF-I）、转化生长因子（TGF-β1）、血小板衍生生长因子（PDGF-AB）、血管内皮生长因子（VEGF）、肝细胞生长因子（HGF）和表皮生长因子（EGF）的浓度来表征PRGF治疗。
接受PRGF治疗的运动员更早恢复活动范围（7±2周对11±3周，P = 0.025），未出现伤口并发症，开始轻度跑步的时间更短（11±1周对18±3周，P = 0.042），恢复训练活动的时间也更短（14±0.8周对21±3周，P = 0.004）。PRGF治疗的肌腱横截面积增加较少（t = 3.44，P = 0.009）。TGF-β1（74.99±32.84 ng/mL）、PDGF-AB（35.62±14.57 ng/mL）、VEGF（383.9±374.9 pg/mL）、EGF（481.5±187.5 pg/mL）和HGF（593.87±155.76 pg/mL）与血小板数量（677±217个血小板/微升）显著相关（P < 0.05）。
肌腱手术管理与自体PRGF的应用相结合可能为促进愈合和功能恢复带来新的可能性。这需要在随机临床试验中进行评估。
