Hada Shinnosuke, Hada Masao, Yoshida Keiichi, Kaneko Haruka, Saita Yoshitomo, Kubota Mitsuaki, Ishijima Muneaki
Department of Orthopaedics, Juntendo University, Tokyo, JPN.
Department of Orthopaedics, Hada Medical Clinic, Tokyo, JPN.
Cureus. 2024 Jan 28;16(1):e53102. doi: 10.7759/cureus.53102. eCollection 2024 Jan.
Background The recommended treatment for anterior cruciate ligament (ACL) injuries in active, sports-oriented patients is reconstructive surgery in order to regain stability and prevent secondary meniscal injuries. However, ACL reconstruction requires a long recovery period and poses issues such as decreased muscle strength due to tendon harvesting and postoperative osteoarthritis (OA) progression, thereby raising significant expectations for the advancement of conservative treatments. Recent studies have shown that platelet-rich plasma (PRP) therapy, which utilizes the tissue repair-promoting property of platelets, is effective for ACL injuries. Methods We administered PRP therapy within six weeks after ACL injury in patients who expressed the desire for an early return to sports through conservative care. After the treatment, patients wore a simple brace that limited deep flexion but placed no restrictions on weight bearing. Four months was the standard goal established for returning to pre-injury condition, and, depending on the target level, timing, and knee condition, we adjusted the additional PRP treatments and rehabilitation approach, gradually authorizing the patients' return to sport. We assessed the ligament repair status by magnetic resonance imaging (MRI) just before the full return to sports. A retrospective survey was conducted to evaluate the status of ligament repair and the condition of return-to-sport in patients with ACL injuries who underwent conservative treatment using PRP. Results The average patient age was 32.7 years and the average treatment was 2.8 PRP sessions. MRI evaluations confirmed that ligament continuity was regained in all cases. All the patients returned to their pre-injury level (Tegner Activity Scale 7.0) in an average of 139.5 days, but there was one instance of re-rupture following the return to sports. Conclusion All patients with ACL injury who underwent PRP therapy regained ligament continuity and returned to sport successfully with only one case of re-rupture.
背景 对于活跃的、以运动为导向的患者，前交叉韧带（ACL）损伤的推荐治疗方法是重建手术，以恢复稳定性并预防继发性半月板损伤。然而，ACL重建需要较长的恢复期，并且存在诸如因取腱导致肌肉力量下降和术后骨关节炎（OA）进展等问题，因此人们对保守治疗的进展寄予厚望。最近的研究表明，利用血小板促进组织修复特性的富血小板血浆（PRP）疗法对ACL损伤有效。方法 对于那些希望通过保守治疗早日恢复运动的ACL损伤患者，我们在损伤后六周内给予PRP治疗。治疗后，患者佩戴一种简单的支具，该支具限制深度屈曲但不限制负重。设定四个月为恢复到伤前状态的标准目标，并根据目标水平、时间和膝关节状况，调整额外的PRP治疗和康复方法，逐步批准患者恢复运动。在完全恢复运动前，我们通过磁共振成像（MRI）评估韧带修复状态。对接受PRP保守治疗的ACL损伤患者进行回顾性调查，以评估韧带修复状况和恢复运动的情况。结果 患者平均年龄为32.7岁，平均接受2.8次PRP治疗。MRI评估证实所有病例韧带连续性均恢复。所有患者平均在139.5天恢复到伤前水平（Tegner活动量表7.0），但有1例在恢复运动后再次断裂。结论 所有接受PRP治疗的ACL损伤患者均恢复了韧带连续性，并成功恢复运动，仅1例再次断裂。
