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Use of platelet concentration, bone plug may accelerate healing process in ACL reconstruction

Thursday, December 11 2008 | Comments
Evidence Grade 2 What's This?
The use of platelet concentration appears to improve the graft maturation process in anterior cruciate ligament (ACL) reconstruction, and the use of a bone plug may prevent tunnel widening; however, the use of platelet concentration and bone plug together may not accelerate the healing process, according to a preliminary prospective study.

Researchers evaluated patients who were candidates for ACL reconstruction between January 2005 and December 2006. The 108 patients undergoing ACL reconstruction were divided into 4 groups: a control group (n=27), a group who had platelet concentration (n=26), a group who had a bone plug (n=28), or a group who had both a bone plug and platelet concentration (n=27).

The investigators evaluated the maturation of the graft at the femoral tunnel using magnetic resonance imaging (MRI) maturation criteria, which was defined by a low-intensity signal, absence of the osteoligamentous interface, and no widening of the femoral tunnel. MRI studies were conducted at 3 and 6 months postoperatively.

The results showed that 3 months following the surgery, no between-group differences were noted with regard to MRI maturation criteria. Six months postoperatively, 78% (n=21) of the patients in the control group had a low-intensity signal compared with 100% (n=26) of those in the platelet concentration group, 89% (n=25) in the bone plug group, and 93% (n=25) in the combination group. The difference between the control and the platelet concentration group was statistically significant (P=.036). No significant differences were found between the control group and the other groups.

In addition, at 6 months, tunnel widening was observed in 11% of patients in the bone plug group and in 41% of those in the control group (P=.047). However, no statistical difference was noted in tunnel widening between any other groups.

Furthermore, no statistical differences were observed between any of the groups with regard to osteoligamentous interface. At 6 months, there was no interface between the graft and bone at the femoral tunnel in 67% (n=18) of the control group compared with 88% (n=23) of the platelet concentration group, 68% (n=19) of the bone plug group, and 70% (n=19) of the combination group.

"[W]e recommend the use of [bone plug] to prevent tunnel widening. We believe that there is still not enough evidence to support the use of [platelet concentration] in ACL reconstruction," the investigators concluded. "Further studies are needed to confirm the clinical utility of [platelet concentration]." (Orrego M, et al. Arthroscopy 2008;24:1373-1380.)

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