Autologous IL1-Ra and several growth factors influence on result after double bundle ACL surgery

Abstract

Bone tunnel widening (BTW) appear after knee anterior cruciate ligament (ACL) single bundle technique (SB) reconstruction and could result in ligament laxity or lead to increased failure rates. It could be affected on biomechanical and biomolecular base. Our aim was to establish whether double bundle technique (DB) in combination with biologic treatment of intra-articular application of autologous conditioned serum (ACS) containing endogenous anti-inflammatory cytokines including IL-1Ra and several growth factors, could enhance result of ACL surgery. In prospective, randomized, double-blind trial with four parallel groups, 124 patients were treated. We compared tibial BTW measured by CT-scans in three different postoperative periods. The clinical efficacy was assessed by patient administered outcome instruments (IKDC 2000, LYSHOLM, TEGNER) up to two years following ACL reconstruction in 4 groups of patients regarding different combination of treatment: – A: SB + Placebo; – B: SB + ACS; – C: DB + Placebo; – D: DB + ACS. Postoperative tibial tunnel diameters in all groups were significantly larger than they were directly after surgery. BTW was significantly less in group D than in other groups (P < 0.005). Clinical outcomes were consistently better in patients treated with DB technique, especially in group D, at all data points and for all outcome parameters. Combination of biologic ACS treatment and DB ACL reconstruction give the best postoperative knee stability and influence function recovery and clinical result by affecting BTW. The cause and prevention of BTW must be understood by surgeon to improve surgical technique, choice of graft methods and postoperative treatment regimens.