Effects of Platelet-Rich Osteoconductive–Osteoinductive Allograft Compound on Tunnel Widening of ACL Reconstruction: A Randomized Blind Analysis Study

Abstract

The anterior cruciate ligament (ACL) is a commonly injured ligament in the knee. Bone tunnel widening is a known phenomenon after soft-tissue ACL reconstruction and etiology and the clinical relevance has not been fully elucidated. Osteoconductive compounds are biomaterials providing an appropriate scaffold for bone formation such as a demineralized bone matrix. Osteoinductive materials contain growth factors stimulating bone lineage cells and bone growth. A possible application of osteoinductive/osteoconductive (OIC) material is in ACL surgery. We hypothesized that OIC placed in ACL bone tunnels: (1) reduces tunnel widening, (2) improves graft maturation, and (3) reduces tunnel ganglion cyst formation. To test this hypothesis, this study evaluated the osteogenic effects of demineralized bone matrix (DBM) and platelet-rich plasma (PRP) on tunnel widening, graft maturation, and ganglion cyst formation. This was a randomized controlled clinical trial pilot study. A total of 26 patients that elected to have ACL reconstruction surgery were randomized between the OIC and control group. Measurements of tunnel expansion and graft-tunnel incorporation were conducted via the quantitative image analysis of MRI scans performed at six months after surgery for both groups. No patients had adverse post-operative reactions or infections. The use of OIC significantly reduced tunnel widening (p < 0.05) and improved graft maturation (p < 0.05). Patients treated with OIC had a significantly lower prevalence of ganglion cyst compared to the control group (p < 0.05). The use of OIC has measurable effects on the reduction of tunnel widening, improved graft maturation, and decreased size of ganglion cyst after ACL reconstruction. This study explored the utilization of biologics to minimize bone tunnel widening in ACL reconstruction surgery.

Platelet‐rich plasma augmentation in anterior cruciate ligament reconstruction: Evidence is still too scattered. A scoping review of randomised controlled trials

“…Eleven of the included RCTs (nine series of patients) analysed tibial and/or femoral bone tunnels with MRI [5,22,41,42,46,47,52,53] (four studies with serial evaluations [42,46,47,53]), computed tomography (CT) scan [22,40,58] and X-ray [31]. Two studies documented a significantly reduced tunnel widening in the PRP group [52,53], and one series documented increased cortical bone formation, increased vascular density and reduced oedema in the tibial tunnel [46,47]. On the other hand, the remaining seven studies documented no advantages of PRP augmentation.…”

“…In two of these studies [48, 63], multiple MRI follow‐ups were performed, while for the remaining studies only one MRI was performed. Six studies documented significantly better results in the PRP group in terms of graft maturation, integration and signal intensity [6, 35, 42, 48, 52, 63], while the remaining six studies documented no advantages of PRP augmentation.…”

“…Even though 12 studies addressed this topic, a clear lack of consistency in the literature was found in the approach to the description and analysis of this matter [59,60]. Different MRI techniques were employed, and the timing of MRI follow-ups was far from homogeneous: this implies that different studies investigated different graft healing phases [27], with four studies reporting follow-up results during the so-called 'proliferation phase' [35,42,51,63] and eight studies reporting them during the 'ligamentisation phase' [5,6,19,22,41,48,52,64]. Moreover, MRI parameters (graft signal intensity, signal-to-noise ratio and ADC) were measured at different graft locations and used to evaluate a broad variety of outcomes, such as graft maturation, ligamentisation, integration, revascularisation, microvessel permeability and vascular density.…”

“…Eleven RCTs (nine series of patients) analysed tibial and/or femoral bone tunnels. For this purpose, multiple imaging techniques were employed, including MRI [5,22,41,42,46,47,52,53], CT scan [40,58] and radiograph [31]. The timing of imaging acquisition at follow-up ranged from 6 weeks to 14.7 months postoperatively.…”

“…It was used to evaluate graft maturation in four studies [6,19,42,52], graft ligamentisation in two studies [19,48], graft integration in the femoral and tibial tunnel in four studies [6,19,47,51] and presence of synovial fluid at graft-tunnel interface in one study [6]. Signal-to-noise ratio was used to evaluate either graft maturation [6,22,52], graft integration [51] and graft revascularisation [63], and ADC was employed to evaluate oedema, vascular density and microvessels permeability of the graft [46]. Eleven RCTs (nine series of patients) analysed tibial and/or femoral bone tunnels.…”