Autologous platelet-rich plasma gel to reduce donor-site morbidity after patellar tendon graft harvesting for anterior cruciate ligament reconstruction: a randomized, controlled clinical study
Autologous platelet-rich plasma gel to reduce donor-site morbidity after patellar tendon graft harvesting for anterior cruciate ligament reconstruction: a randomized, controlled clinical study
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DOI：
10.1007/s00167-011-1570-5
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发表时间：
2012-01-01
影响因子：
3.8
通讯作者：
Volpi, P.
中科院分区：
文献类型：
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作者：
Cervellin, M.;de Girolamo, L.;Volpi, P.
骨-髌腱-骨技术(BPTB)治疗前交叉韧带损伤具有较高的供区并发症风险。为了评价富含血小板血浆(PRP)的抗炎作用和促进组织再生的能力，通过对VISA和VAS评分以及肌腱和骨缺损的MRI分析，评估PRP是否能够减轻膝关节前疼痛、跪地疼痛和供区并发症。我们进行了一项临床随机对照研究，将PRP凝胶应用于BPTB重建前交叉韧带后的供区，将40名有重建前交叉韧带指征的年轻运动员随机分为A组(对照组)和B组(PRP组)。将自体PRP凝胶应用于髌骨和肌腱骨塞的取材部位，并通过腱周围缝合来稳定。在12个月的随访中，所有患者都接受了临床检查，并填写了VAS和VISA问卷，分别评估膝关节的平均每日疼痛和涉及膝关节的特定活动期间的疼痛。术后视觉模拟评分A组和B组分别为84.5+/-A11.8和97.8+/-A2.5(P=0.041)，两组间差异无统计学意义(1+/-A1.4和0.6+/-A0.9)。在85%的PRP组患者中，新生骨组织(70%的骨间隙被填充)令人满意地填充了胫骨和髌骨缺损处，而对照组患者这一比例仅为60%，但这一差异没有统计学意义。研究表明，PRP在减少BPTB重建前交叉韧带后供体部位的主观疼痛方面是有效的。然而，这一方法值得进一步研究，以证实PRP的有效性并阐明其作用机制。前瞻性随机对照研究，I级。
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 +/- A 11.8 and 97.8 +/- A 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 +/- A 1.4 and 0.6 +/- A 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.