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. 2014:2014:789317.
doi: 10.1155/2014/789317. Epub 2014 Nov 6.

The Potentially Positive Role of PRPs in Preventing Femoral Tunnel Widening in ACL Reconstruction Surgery Using Hamstrings: A Clinical Study in 51 Patients

Konstantinos A Starantzis  1 , Dimitrios Mastrokalos  1 , Dimitrios Koulalis  1 , Olympia Papakonstantinou  1 , Panayiotis N Soucacos  1 , Panayiotis J Papagelopoulos  1
Affiliations

The Potentially Positive Role of PRPs in Preventing Femoral Tunnel Widening in ACL Reconstruction Surgery Using Hamstrings: A Clinical Study in 51 Patients

Konstantinos A Starantzis et al. J Sports Med (Hindawi Publ Corp). 2014.

Abstract

Purpose. In this study, the early and midterm clinical and radiological results of the anterior cruciate ligament (ACL) reconstruction surgery with or without the use of platelet rich plasma (PRP) focusing on the tunnel-widening phenomenon are evaluated. Methods. This is a double blind, prospective randomized study. 51 patients have completed the assigned protocol. Recruited individuals were divided into two groups: a group with and a group without the use of PRPs. Patients were assessed on the basis of MRI scans, which were performed early postoperatively and repeated at least one-year postoperatively. The diameter was measured at the entrance, at the bottom, and at the mid distance of the femoral tunnel. Results. Our study confirmed the existence of tunnel widening as a phenomenon. The morphology of the dilated tunnels was conical in both groups. There was a statistical significant difference in the mid distance of the tunnels between the two groups. This finding may support the role of a biologic response secondary to mechanical triggers. Conclusions. The use of RPRs in ACL reconstruction surgery remains a safe option that could potentially eliminate the biologic triggers of tunnel enlargement. The role of mechanical factors, however, remains important.

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Figures

Figure 1
Figure 1
PRPs added between the strands of the graft and left to form a clot before the graft is pulled into the tunnel.
Figure 2
Figure 2
Once the graft is fixed within the tunnel, the remaining 3 mL of PRP is injected into the femoral tunnel using an introducer.
Figure 3
Figure 3
Schematic definition of different sites of measurements within the femoral tunnelin this study.
Figure 4
Figure 4
Comparison of femoral tunnel's axial MRI cuts performed on the same patient 1 and 12 months following ACL reconstruction. (a) Proximal 1 month, (b) middistance 1 month, (c) distal 1 month, (d) proximal 12 months, (e) middistance 12 months, and (f) distal 12 months.
Figure 5
Figure 5
CG mean tunnel dilation at the entrance, middistance, and bottom end of the tunnel at 12 months. Horizontal red line shows the mean drilled diameter and shadowed area demonstrates the shape of tunnel dilation (conical). PRPG mean tunnel dilation at the entrance, middistance, and bottom end of the tunnel at 12 months. Horizontal red line shows the mean drilled diameter and shadowed area demonstrates the shape of tunnel dilation (conical).
See this image and copyright information in PMC

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