Abstract
Background: There has been a recent emergence in the use of orthobiologics, including platelet-rich plasma (PRP) and bone marrow concentrate (BMC), in the treatment of various musculoskeletal conditions. The goal of this study was to determine if injection of BMC and platelet products into partial and full-thickness anterior cruciate ligament (ACL) tears can facilitate primary ligament healing in patients failing conservative care, resulting in improved outcomes compared to exercise therapy.Methods: Patients were randomized to either exercise therapy or percutaneous injection of autologous BMC with PRP and platelet lysate into the ACL under fluoroscopic guidance. Pain and function were assessed at baseline and at 1, 3, 6, 12, and 24 months. Baseline and 6-month post-treatment magnetic resonance imaging (MRI) were obtained to evaluate interval healing. Laxity was assessed using the Telos device.Results: There was significant improvement in functional outcomes in the BMC group, compared to base-line for LEFS at time points 3 up to 24 months s = 0.000000005), and significant improvement in pain in the BMC group at 6 (p = 0.00054), 12 (p = 0.00127), and 24 months (p = 0.002). There was no significant improvement in pain or function at any time point in the exercise therapy group. There was significant improvement in ACL MRI ImageJ quantitative assessment in the BMC group (p = 0.001) and no difference in the exercise group (p > 0.05). No serious adverse events were reported.Conclusion: Autologous BMC and platelet product injection into ACL tears improved patient function compared to exercise, observed through 24 months. Patients treated with BMC demonstrated quantitative improvements in post-treatment MRI scans suggestive of interval ligament healing.
Highlights
The anterior cruciate ligament (ACL) is a key ligamentous stabilizer of the knee that prevents anterior translation of the tibia and serves to restrain tibial rotation
P injections improved Kpeayinwaonrddsf:uanncttieornioarmcoruncgiaintedilvigidaumaelsnwt, iAthCsLevteearer,kbnoeneeOmAawrrhoowwcoernecpenretrvaioteus(BlyMreCc)a,lcpiltartaenltettso,croengseenrevraattiivvee mceadreic.iAnelthough results indicated significant improvement, clinically important change did not occur until F2
Ajuied et al found that 20.3% of ACL-injured knees progressed to either moderate or severe osteoarthritis within 10 years, compared to 4.9% incidence of osteoarthritis in the uninjured contralateral knee.[6]
Summary
The anterior cruciate ligament (ACL) is a key ligamentous stabilizer of the knee that prevents anterior translation of the tibia and serves to restrain tibial rotation. It is the most commonly injured ligament in the body and occurs at an estimated incidence of 200,000 cases each year in the United States, resulting in approximately 150,000 ACL reconstructive surgeries performed yearly.[1,2]. A one-arm design is a limitation of this study
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