Evaluation of the tibial tunnel after intraoperatively administered platelet‐rich plasma gel during anterior cruciate ligament reconstruction using diffusion weighted and dynamic contrast‐enhanced MRI

Abstract

Purpose: To evaluate effect of platelet-rich plasma gel (PRPG), locally administered during the anterior cruciate ligament (ACL) reconstruction, with two MRI methods. The proximal tibial tunnel was assessed with diffusion weighted imaging (DWI) and with dynamic contrastenhanced imaging (DCE-MRI). Materials and Methods:In 50 patients, standard arthroscopic ACL reconstructions were performed. The patients in the PRPG group (n ¼ 25) received a local application of PRPG. The proximal tibial tunnel was examined by DWI and DCE-MRI, which were used to calculate apparent diffusion coefficient (ADC) values, as well as the contrast enhancement gradient (G enh ) and enhancement factor (F enh ) values.Results: At 1 month, the calculated average ADC value in the PRPG group was significantly lower than in the control group. At 2.5 and at 6 months, G enh was significantly higher in the PRPG group. There were no significant differences in F enh between the groups at any control examination.Conclusion: DWI and DCE-MRI measurements indicate a reduced extent of edema during the first postoperative month as well as an increased vascular density and microvessel permeability in the proximal tibial tunnel at 1 and 2.5 postoperative months as the effect of the application of PRPG.

PRP Augmentation for ACL Reconstruction

“…Finally, with regard to positive PRP effects, Rupreht et al were the only ones documenting benefit in the bony tunnel/graft area. In a randomized study [ 47 ] they showed that PRP administration reduced edema around the tibial tunnel during the first postoperation month and also increased vascular density and microvessel permeability in the proximal tibial tunnel at 1 and 2.5 months' MRI evaluation, thus suggesting that PRP is most effective in the early phases of healing. In another paper [ 43 ], the same authors reported that PRP increased cortical bone formation around the tibial tunnel wall at 6 months followup, thus suggesting that PRP might effectively contribute to graft-bone integration.…”

“…The application of PRP has been hypothesized to improve graft integration within the tunnels. Concerning the osteoligamentous integration, Rupreht et al showed increased vascular density and microvessel permeability in the proximal tibial tunnel at 1 and 2.5 months' MRI evaluation, as well as reduced bone edema around the tunnel and increased cortical bone formation around the tibial tunnel wall at 6 months followup [ 43 , 47 ]. Vogrin et al [ 49 ] also showed a significantly higher neovascularization 4–6 weeks after PRP administration, but the advantage of PRP was not confirmed at further followup, thus suggesting that PRP is most effective in the early phases of healing.…”

Quantitative Evaluation of Growth Plates around the Knees of Adolescent Soccer Players by Diffusion-Weighted Magnetic Resonance Imaging

“…Two DWI acquisitions with different b values enable calculation of ADC map. Higher ADC values correspond to elevated diffusion in the extracellular space; the motion of water is less restricted [ 20 ]. In areas with high cellularity, molecular water mobility is impeded, yielding lower ADC values [ 20 ].…”

“…Higher ADC values correspond to elevated diffusion in the extracellular space; the motion of water is less restricted [ 20 ]. In areas with high cellularity, molecular water mobility is impeded, yielding lower ADC values [ 20 ]. One of the most important findings of this study is the feasibility of DWI-MRI to detect subtle, activity-related changes in the growth plates around the knees of adolescent soccer players.…”

“…Diffusion-weighted MR imaging (DWI) is a novel addition to the MR sequences which provides quantitative information on microscopic movements of water at the cellular level [ 15 ]. In musculoskeletal system, DWI has been particularly useful for the differentiation of metastatic from osteoporotic vertebral fractures, for the evaluation of bone marrow pathology, such as infection and haematological malignancies, and also for the detection of bone metastases and their response to treatment [ 15 – 20 ]. The aim of the current study was to evaluate usage of DWI in the chronic, sports activity-related disturbances of growth plates.…”