Platelet Rich Plasma Helps Patients Overcome ACL Reconstructions Sooner
Paul Fleissner Jr., M.D., Pediatric and Adolescent Sports Medicine Specialist, Crystal Clinic Orthopaedic Center, Orthopaedic Focus Winter 2011
With the increasing number of children and adolescents playing sports, there has been a corresponding increase in the number of anterior cruciate ligament (ACL) injuries.
ACL reconstruction has undergone a significant evolution during the past several decades. Many of the initial changes focused on improved technique with more anatomic placement of the graft and better fixation.
However, there is still a percentage of patients who, in spite of all of this, have unsatisfactory outcomes.
These patients still have inadequate bony ingrowth, ligamentization or vascularization of their graft. Research needs to find a better answer for these patients. Current research and development efforts focus on the biology of healing, stimulating the body’s natural healing process and improving outcomes.
Platelet-rich plasma (PRP) is one of these developments. PRP is blood processed to contain high concentrations of platelets and growth factors. It is produced from a patient’s own blood, which is spun down in a centrifuge to concentrate the platelets, which contain the growth factors.
These growth factors enhance bone and soft tissue healing, which include:
They also have been shown to improve the ingrowth of blood vessels to injured or operated areas.
Surgeons began to look for a solution for patients who underwent an ACL reconstruction but had a suboptimal result. Initially, PRP was used with ACL reconstructions to try to improve outcomes, with the thought that bony ingrowth, ligamentization and vascularization could be improved.
The initial results were surprisingly good. Physical therapists noticed a significant difference between patients who were administered PRP and others under their care undergoing rehabilitation. Therapists began to inquire what was being done differently.
Repeatedly, patients reported that their knee felt so good that they just initiated their activities on their own. They were completing physical therapy within four months postoperatively on a regular basis with many of them returning to sports on their own prior to that time, though this is not encouraged.
Patients were not getting the typical atrophy of their quadriceps that usually occurs after surgery, and they regained neuromuscular control of their leg very quickly.
Twenty years ago, it was routine for the patient to be out of sports for a year after ACL reconstruction surgery. In the years since, with improvement in technique and rehabilitation, there has been a steady decline in the time required to return to sports.
Currently, most patients return to sports six to nine months after a reconstruction. Anything that can be done to safely return a patient to sports and/or work quicker is greatly appreciated by the patient, coaches and employers, as well as insurers.
The next step is to determine whether the effect of PRP can be extended by increasing the amount of time it stays in the surgical area and releases its growth factors. Currently, we are retrospectively reviewing the first group of patients and preparing to embark on a prospective study of ACL reconstructions using PRP and PRP with a carrier.
The field of orthopaedics is in its infancy and vast changes are ahead. Many of those changes will involve the biology of bone, cartilage and ligaments. This is an exciting and challenging time, and orthopaedics will have much to offer patients in the very near future.