Prospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jun 18, 2021; 12(6): 423-432
Published online Jun 18, 2021. doi: 10.5312/wjo.v12.i6.423
Has platelet-rich plasma any role in partial tears of the anterior cruciate ligament? Prospective comparative study
Juan Pablo Zicaro, Ignacio Garcia-Mansilla, Andres Zuain, Carlos Yacuzzi, Matias Costa-Paz
Juan Pablo Zicaro, Ignacio Garcia-Mansilla, Andres Zuain, Carlos Yacuzzi, Matias Costa-Paz, Knee Division, Hospital Italiano de Buenos Aires, Buenos Aires 1181, Argentina
Author contributions: Zicaro JP and Garcia-Mansilla I designed the study and drafted the manuscript; Zuain A performed the literature review and edited the manuscript; Yacuzzi C, Zicaro JP and Costa-Paz M provided the patient selection and clinical procedures; All authors approved the final draft of the manuscript.
Institutional review board statement: The study was reviewed and approved by the Ethics in Investigation Committee Institutional Review Board (Approval No. 5624).
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: No conflicts of interests.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ignacio Garcia-Mansilla, MD, Academic Research, Surgeon, Knee division, Hospital Italiano de Buenos Aires, Peron 4190, Buenos Aires 1181, Argentina. ignaciogmansilla@gmail.com
Received: December 30, 2020
Peer-review started: December 30, 2020
First decision: January 24, 2021
Revised: February 18, 2021
Accepted: May 7, 2021
Article in press: May 7, 2021
Published online: June 18, 2021
Processing time: 162 Days and 23 Hours
Abstract
BACKGROUND

Partial tears of the anterior cruciate ligament (ACL) are frequent, and there is still considerable controversy surrounding their diagnosis, natural history and treatment.

AIM

To examine patient-reported outcomes, physical examination and magnetic resonance imaging (MRI) findings of partial ACL tears treated with an intraarticular injection of platelet-rich plasma (PRP) compared to a control group.

METHODS

From January 2015 to November 2017, consecutive patients from a single institution with partial ACL tears treated nonoperatively were prospectively evaluated. Partial tears were defined as a positive Lachman test with a clear end-point, a negative pivot-shift and less than 3 mm of side-to-side difference using the KT1000 arthrometer. Patients in group 1 were treated with one intraarticular injection of PRP and specific physical therapy protocol. Control group consisted of patients treated only with physical therapy. Prospective analyzed data included physical examination, Tegner activity level and Lysholm and International Knee Documentation Committee scores. Baseline MRI findings and at 6 mo follow-up were reviewed. Failure was defined as those patients with clinical instability at follow-up that required a subsequent ACL reconstruction.

RESULTS

A total of 40 patients where included, 21 treated with PRP injection with a mean follow-up of 25 mo [standard deviation (SD): 3.6] and 19 in the control group with a mean follow-up of 25 mo (SD: 5.68). Overall failure rate was 32.0% (n = 13). No significant differences were observed between groups regarding subjective outcomes, return to sport and failure rate. MRI findings revealed an improvement in the ACL signal in half of the patients of both groups. However, we did not find a significant relationship between MRI findings and clinical outcomes.

CONCLUSION

Overall, 95.0% of patients returned to sports at a mean follow-up of 25 mo. Mean time to return to sports was 4 mo. Out of these patients, almost 30.0% in each group had a new episode of instability and required surgery at a median time of 5 mo in group 1 and 8 mo in group 2. The addition of PRP alone was not sufficient to enhance any of the outcome measures evaluated, including MRI images, clinical evaluation and failure rate.

Keywords: Anterior cruciate ligament; Partial tears; Platelet-rich plasma; Non-operative treatment

Core Tip: This was a prospective comparative study with 40 patients seeking to evaluate the effect of platelet-rich plasma on partial tears of the anterior cruciate ligament. Prospective analyzed data included physical examination, Tegner activity level and Lysholm and International Knee Documentation Committee scores. Baseline magnetic resonance imaging findings and at 6 mo follow-up were also reviewed.