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.


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.

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