Summary
BACKGROUND: Arthroscopic reconstruction is a standard surgical procedure in cases of symptomatic knee instability due to rupture of the anterior cruciate ligament. Bone-tendon-bone and hamstring tendon grafts are both in use for anterior cruciate ligament reconstruction. There are no significant differences between the two types of graft in relation to function scores, but there is a difference in anteroposterior stability when measured on the KT-2000 arthrometer: knee joints after reconstruction with bone-tendon-bone autografts are more stable than those reconstructed with hamstring tendon autografts. PURPOSE: To improve knee stability after anterior cruciate ligament reconstruction with a hamstring graft and use of platelet-derived growth factors. BASIC PROCEDURE: Platelet-leukocyte gel was produced from platelet-leukocyte-rich plasma prepared from a unit of whole blood in an autologous platelet separator. The gel was applied locally, after hamstring graft placement. Fifty patients were included in the study: 25 in the platelet gel group, 25 in a control group. We evaluated anteroposterior knee stability with the KT-2000 arthrometer before surgery and at 3 and 6 months after surgery. MAIN FINDINGS: Patients treated with the gel demonstrated significantly better anteroposterior knee stability than patients in the control group. The calculated improvements in knee stability at 6 months were 1.3 ± 1.8 mm in the control group and 3.1 ± 2.5 mm in the platelet gel group (P = 0.011). PRINCIPAL CONCLUSION: Platelet-leukocyte gel, applied locally, can improve knee stability in surgery for reconstruction of the anterior cruciate ligament.
Similar content being viewed by others
References
McCulloch P, Lattermann C, Boland A, Bach B (2007) An illustrated history of anterior cruciate ligament surgery. J Knee Surg 20: 95–104
Johnson RJ, Eriksson E, Haggmark T, Pope MH (1984) Five- to ten-year follow-up evaluation after reconstruction of the anterior cruciate ligament. Clin Orthop Relat Res 183: 122–40
Sajovic M, Vengust V, Komadina R, Tavcar R, Skaza K (2006) A prospective, randomized comparison of semitendinosus and gracilis tendon versus patellar tendon autografts for anterior cruciate ligament reconstruction: five years follow up. Am J Sports Med 34: 1933–40
Miller SL, Gladstone JN (2002) Graft selection in anterior cruciate ligament reconstruction. Orthop Clin North Am 33: 675–83
Deehan DJ, Cawston TE (2005) The biology of integration of the anterior cruciate ligament. J Bone Joint Surg 87: 889–95
Gomez DE, Alonso DF, Yoshiji H, Thorgeirsson UP (1997) Tissue inhibitors of metalloproteinases: structures, regulation and biological functions. Eur J Cell Biol 74: 111–22
Marumo K, Saito K, Yamagishi T, Fujii K (2005) The 'ligamentization' process in human anterior cruciate ligament reconstruction with autogenous patellar and hamstring tendons: a biochemical study. Am J Sports Med 33: 1166–73
Werner S, Grose R (2003) Regulation of wound healing by growth factors and cytokines. Physiol Rev 83: 835–70
Hildebrand KA, Woo SL, Smith DW, Allen CR, Deie M, Taylor BJ, et al (1985) The effects of platelet-derived growth factor-BB on healing of the rabbit medial collateral ligament. An in vivo study. Am J Sports Med 26: 549–54
Batten ML, Hansen JC, Dahners LE (1996) Influence of dosage and timing of application of platelet-derived growth factor on early healing of the rat medial collateral ligament. J Orthop Res 14: 736–41
Hsu C, Chang J (2004) Clinical implications of growth factors in flexor tendon wound healing. J Hand Surg [Am] 29: 551–63
Rozman P, Bolta Z (2007) Use of platelets growth factors in treating wounds and soft tissue injuries. Acta Dermatoven APA 16: 156–65
Smrke D, Gubina B, Domanovič D, Rozman P (2007) Allogeneic platelet gel with autologous cancellous bone graft for the treatment of a large bone defect. Eur Surg Res 39: 170–4
Weiler A, Förster C, Hunt P, Falk R, Jung T, Unterhauser FN, et al (2004) The influence of locally applied platelet-derived growth factor-BB on free tendon graft remodeling after anterior cruciate ligament reconstruction. Am J Sports Med 32: 881–91
Tabata Y (2003) Tissue regeneration based on growth factor release. Tissue Eng 9: S5–15
Shelbourne KD, Nitz P (1990) Accelerated rehabilitation after anterior cruciate ligament reconstruction. Am J Sports Med 18: 292–9
Everts PA, Knape JT, Weibrich G, Schonberger JP, Hoffmann J, Overdevest EP, et al (2006) Platelet-rich plasma and platelet gel: a review. J Extra Corpor Technol 38: 174–87
Everts PA, Hoffmann J, Weibrich G, Mahoney CB, Schönberger JP, van Zundert A, et al (2006) Differences in platelet growth factor release and leucocyte kinetics during autologous platelet gel formation. Transfus Med 16: 363–8
Hefti F, Muller W, Jakob RP, Staubli HU (1993) Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc 1: 226–34
Tagner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198: 43–9
Daniel MD, Malcom LL, Losse G, Stone ML, Sachs R, Burk R (1985) Instrumented measurement of anterior laxity of the knee. J Bone Joint Surg Am 67: 720–6
Shelbourne KD, Gray T (1997) Anterior cruciate ligament reconstruction with autogenous patellar tendon graft, followed by accelerated rehabilitation: a two- to nine-year follow-up. Am J Sports Med 25: 786–95
Fujimoto E, Sumen Y, Urabe Y (2004) An early return to vigorous activity may destabilize anterior cruciate ligaments reconstructed with hamstring grafts. Arch Phys Med Rehabil 85: 298–302
Amiel D, Kleiner JB, Roux RD, Harwood FL, Akeson WH (1986) The phenomenon of 'ligamentization': anterior cruciate ligament reconstruction with autogenous patellar tendon. J Orthop Res 4: 162–72
Abe S, Kurosaka M, Iguchi T, Yoshiya S, Hirohata K (1993) Light and electron microscopic study of remodeling and maturation process in autogenous graft for anterior cruciate ligament reconstruction. Arthroscopy 9: 394–405
Rougraff BT, Shelbourne KD (1999) Early histologic appearance of human patellar tendon autografts used for anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 7: 9–14
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Vogrin, M., Rupreht, M., Crnjac, A. et al. The effect of platelet-derived growth factors on knee stability after anterior cruciate ligament reconstruction: a prospective randomized clinical study. Wien Klin Wochenschr 122 (Suppl 2), 91–95 (2010). https://doi.org/10.1007/s00508-010-1340-2
Issue Date:
DOI: https://doi.org/10.1007/s00508-010-1340-2