Istituto Clinico Humanitas IRCCS, Rozzano, Milano, Italy.
Knee Surg Sports Traumatol Arthrosc. 2012 Jan;20(1):114-20. doi: 10.1007/s00167-011-1570-5. Epub 2011 Jun 16.
Bone-patellar tendon-bone technique (BPTB) for anterior cruciate ligament injuries is associated with a higher risk of donor-site morbidity. To evaluate whether platelet-rich plasma (PRP), due to its anti-inflammatory properties and capacity to stimulate tissue regeneration, was able to reduce the anterior knee pain, the kneeling pain, and donor-site morbidity, as evidenced by evaluation of VISA and VAS scoring scales and MRI analysis of the tendon and bone defect, we performed a clinical randomized controlled study where PRP gel was applied to donor site after ACL reconstruction with BPTB.
Forty young athletes with the indication of ACL reconstruction with patellar tendon grafts were randomly assigned to group A (n = 20 patients, control group) or group B (n = 20 patients, PRP group). The autologous PRP gel was applied to both the patellar and tendon bone plug harvest site and stabilized by the peritenon suture. At 12-month follow-up, all patients underwent clinical examination and VAS and VISA questionnaires, respectively, evaluating the average daily pain of the knee and the pain during particular activities involving the knee, were filled. MRI at the same time point was also performed.
VISA scores were significantly higher in the patients treated with PRP (84.5 ± 11.8 and 97.8 ± 2.5 for group A and for group B; P = 0.041), whereas no significant difference in postoperative VAS scores between the two groups was observed (1 ± 1.4 and 0.6 ± 0.9 for group A and group B, n.s.). In 85% of PRP group patients, the tibial and patellar bone defect was satisfactorily filled by new bony tissue (>70% of bone gap filled), whereas this percentage was just of 60% in control group patients, but this difference was not statistically significant.
The study shows the usefulness of PRP in reducing subjective pain at the donor-site level after ACL reconstruction with BPTB. However, this approach deserves further investigations to confirm PRP efficacy and to elucidate its mechanism of action.
Prospective randomized controlled study, Level I.
前交叉韧带损伤采用髌腱-骨（BPTB）技术，与供体部位发病率较高相关。为了评估富含血小板的血浆（PRP）是否由于其抗炎特性和刺激组织再生的能力，能够降低前膝疼痛、跪地疼痛和供体部位发病率，我们进行了一项临床随机对照研究，其中在 ACL 重建后将 PRP 凝胶应用于 BPTB 的供体部位。
40 名有 ACL 重建髌腱移植指征的年轻运动员被随机分为 A 组（n=20 例，对照组）或 B 组（n=20 例，PRP 组）。自体 PRP 凝胶被应用于髌骨和肌腱骨栓采集部位，并通过腱旁缝线固定。在 12 个月的随访中，所有患者分别接受临床检查和 VAS 和 VISA 问卷评估，分别评估膝关节的平均日常疼痛和涉及膝关节的特定活动时的疼痛，并填写问卷。同时还进行了 MRI。
PRP 治疗组的 VISA 评分显著更高（A 组和 B 组分别为 84.5±11.8 和 97.8±2.5；P=0.041），而两组术后 VAS 评分无显著差异（A 组和 B 组分别为 1±1.4 和 0.6±0.9，n.s.）。在 PRP 组 85%的患者中，胫骨和髌骨骨缺损被新的骨组织充分填充（>70%的骨间隙填充），而对照组患者的这一比例仅为 60%，但这一差异无统计学意义。
该研究表明，PRP 在减少 BPTB 后 ACL 重建供体部位的主观疼痛方面是有用的。然而，这种方法需要进一步的研究来确认 PRP 的疗效，并阐明其作用机制。
前瞻性随机对照研究，I 级。
