Sports Medicine Research: In the Lab & In the Field: PRP Doesn’t Spell Relief After ACL Reconstructions (Sports Med Res)

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Tuesday, May 29, 2018

PRP Doesn’t Spell Relief After ACL Reconstructions

Effect of Intraoperative Platelet-Rich Plasma Treatment on Postoperative Donor Site Knee Pain in Patellar Tendon Autograft Anterior Cruciate Ligament Reconstruction: A Double-Blind Randomized Controlled Trial

Walters BL, Porter DA, Hobart SJ, Bedford BB, Hogan DE, McHugh MM, Klein DA, Harousseau K, Nicholas SJ. Am J Sport Med. 2018. [Epub Ahead of Print].

Take Home Message: Patients that received platelet-rich plasma during an anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft had similar patellar defect size and patient-reported outcomes compared with patients that did not receive the injection.

https://upload.wikimedia.org/wikipedia/commons/1/18/Marines_rehabilitate_at_MCB_Hawaii_S.M.A.R.T_center_150406-M-QA266-162.jpg
The bone-patellar tendon-bone autograft is a common anterior cruciate ligament (ACL) reconstruction technique; however, there is a high incidence of anterior knee pain among patients that underwent this surgery. Many researchers (see list below) examined if platelet-rich plasma (PRP) injection could enhance tissue repair; however, there is very few well-designed studies to support its use to improve graft site healing and reduce the risk of post-operative anterior knee pain after an ACL reconstruction. Therefore, the authors of this clinical trial evaluated the efficacy of intraoperatively applied autologous PRP in reducing post-operative kneeling pain after an ACL reconstruction with bone-patellar tendon-bone autograft. Fifty patients (~ 30 years of age) undergoing bone-patellar tendon-bone ACL autograft reconstruction between 2011 to 2015 were randomized to the PRP (27 participants) or sham (23 participants) treatment. In either case, blood was drawn before starting anesthesia and either discarded (sham) or processed for preparation of a PRP gel to be mixed with donor site bone chips and inserted into the patellar defect. The participant, surgeon, and other research staff were unaware of who received PRP. At 12 weeks, 6 months, 1 year, and 2 years after surgery, participants completed International Knee Documentation Committee (IKDC) forms and visual analog scale pain scores for activities of daily living and kneeling. The authors also assessed graft site healing with magnetic resonance imaging between 6 to 9 months post-surgery. The authors found that pain with activities of daily living or kneeling never differed between groups. The authors also noted that the patellar defect site was no different between groups.

This double-blind randomized controlled trial suggests that PRP fails to reduce pain or patellar defect size after bone-patellar tendon-bone autograft reconstruction. While some researchers believe PRP offers better relief for early post-operative pain, these researchers looked at mid- to long-term effects. Therefore, more clinical trials are necessary determine if and when PRP may be beneficial. However, it appears from this study that any short-term benefits that may be related to early pain relief (e.g., ability to facilitate early range of motion) failed to offer the participants any sustained benefits. On the plus side, there were no negative effects following this treatment. Currently, medical professionals should be aware that anterior knee pain after ACL reconstruction with bone-patellar tendon-bone autograft continues to be a problem, and that patients should be educated accordingly.

Questions for Discussion: Do you believe PRP may be helpful with a different surgery? What are your thoughts/experiences with PRP therapy?

Written by: Jane McDevitt
Reviewed by: Jeffrey Driban

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