The Clinical Outcomes of Preserved Remnant Technique, Fibrin Clots, and Platelet Rich Plasma in Anatomic Double-Bundle ACL Reconstruction
ESSKA Academy. MIYATAKE S. May 12, 2018; 218163
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Objectives: Preserved remnant in ACL reconstruction is believed to enhance graft healing. Fibrin clots possess properties necessary for structural support as well as a delivery mechanism of platelet-derived growth factors. Platelet-rich plasma(PRP) containing various growth factors and cytokines may facilitate the healing of tendon and ligament. The purpose of this study was to evaluate whether remnant preservation or addition of fibrin clots or PRP would improve clinical outcomes in the anatomic double-bundle ACL reconstruction.

Methods: Total of 66 patients who underwent anatomic double-bundle ACL reconstruction using a semitendinosus graft were enrolled in this study. Operative techniques were as follows. Remnant resection (RR) group (n=21):Anatomic double-bundle reconstruction without remnant tissue preservation was performed with trans-tibial technique described by Yasuda(2004). Preserved remnant(PR) group(n=25): Anatomic double bundle reconstruction with remnant tissue preservation which was also described by Yasuda(2012). Fibrin clot(FC) group(n=10):The same technique as RR group were performed with two fibrin clots stitched to the graft. PRP group(n=10):The same technique as RR group were performed with 1 ml of platelet-rich plasma applied over the graft. Lysholm knee score and International Knee Documentation Committee(IKDC) rating system was used for clinical evaluation. Kneelax-3(K3) arthrometer was measured by a blinded and experienced physical therapist to evaluate side-to-side anterior laxity with the patient's knee at 20 degrees of flexion under an anterior drawer force of 133 N. The values of K3 were divided into the following five grades: Grade E <±1mm, Grade G < ±2mm, Grade A < ±3mm, Grade F < ±5mm, Grade P > 5mm. Postoperative results of PR group, FC group and PRP group in each examination were compared with RR group.

Results: There was no significant difference in postoperative Lysholm knee scores and K3 values among RR, PR, FC, and PRP groups:(99.5±1.5, 99.0±2.4, 98.1±5.4, ,and 100.0±0 and 1.40±2.84mm, 1.22±1.97mm, -0.41±1.79mm, and 0.05±0.93mm respectively). Proportions of postoperative IKDC (A:B:C:D) were (8:11:2:0), (17:7:1:0), (6:3:1:0), ,and (10:0:0:0) in the RR, PR, FC, and PRP group. IKDC was significantly better with PRP as compared with RR (P=0.0018) but otherwise there was no significant difference. Proportions of postoperative K3 values (E:G:A:F:P) were (5:5:4:5:2), (8:3:9:4:1), (3:4:2:1:0), , and (7:3:0:0:0) in the RR, PR, FC, and PRP group. Postoperative K3 value was significantly better with PRP group than RR group(P=0.0468).

Conclusions: The use of PRP in ACL reconstruction improved IKDC rating and K3 value as compared with control. Remnant preservation and the use of fibrin clots in ACL reconstruction provided as good as clinical outcomes as usual surgery. Slightly lower scores in the fibrin clot group, although not statistically significant, could be explained by overcorrection of the ligament which can be ameliorated by postoperative rehabilitation.

ACL, PRP, Fibrin clot, Remnant preservation
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