Advances in Clinical and Experimental Medicine
2017, vol. 26, nr 2, March-April, p. 193–199
Publication type: original article
The effect of platelet-rich plasma in bone-tendon integration
1 Faculty of Medicine, Adiyaman University, Adıyaman, Turkey
2 Department of Orthopedics and Traumatology, Yıldırım Beyazıt University, Ankara, Turkey
3 Department of Orthopedics and Traumatology, Faculty of Medicine, Acibadem University, İstanbul, Turkey
4 Department of Histology and Embryology, Faculty of Medicine, Marmara University, İstanbul, Turkey
Background. The operative reconstruction of a torn or insufficient anterior cruciate ligament has become a routine surgical procedure in orthopedics. The long-term success of an anterior cruciate ligament reconstruction depends on the ability of the graft to heal adequately in a bone tunnel. Investigators studying reconstructions described healing within a tunnel as osseous ingrowth and incorporation. In particular, helping the healing using autologous material for the best integration process was a new idea that helped us to set up this study.
Objectives. The purpose of this study is to show the effect of platelet-rich plasma on bone-tendon healing.
Material and Methods. Ten New Zealand rabbits were used. The study had 2 groups: (1) a study group including the right extremities of rabbits in which tendon-bone integration was strengthened by plateletrich plasma and (2) a control group including the left extremities of rabbits in which tendon-bone integration was without platelet-rich plasma. On the 56th day postoperatively, the portion of the distal femur containing the tunnel was amputated following the euthanization process for histological evaluation.
Results. In the histological evaluation of the tendon-integrated bone segments with platelet-rich plasma, the integration of tendon in the bone was successful without any necrosis formation in most of the tissues. However, in the control group without platelet-rich plasma, the integration was distorted in many zones and some cystic morphologies were present.
Conclusion. The findings of this study showed that using platelet-rich plasma during tendon-to-bone implantation has positive effects histologically. In the literature, many studies are available that have investigated the effect of platelet-rich plasma on anterior cruciate surgery radiologically. However, the histological findings are more reliable than radiological findings because bone-tendon integration is a biological process.
platelet-rich plasma, anterior cruciate ligament, tendon, integration, revision surgery
- Ventura A, Terzaghi C, Borgo E, Verdoia C, Gallazzi M, Failoni S. Use of growth factors in ACL surgery: Preliminary study. J Orthop Traumatol. 2005;6:76–79.
- Ferrari JD, Bach BR. Isolated anterior cruciate ligament injury. In: Chapman MW, ed. Chapman’s Orthopaedic Surgery. Philadelphia, PA: Lip-pincott, Williams and Wilkins; 2001:2347–2359.
- Hamner DL, Brown CH Jr, Steiner ME, et al. Hamstring tendon grafts for reconstruction of the anterior cruciate ligament: Biomechanical evaluation of the use of multiple strands and tensioning techniques. J Bone Joint Surg Am. 1999;81:549–557.
- Kurosaka M, Yoshiya S, Andrish JT. A biomechanical comparison of different surgical techniques of graft ﬁxation in anterior cruciate ligament reconstruction. Am J Sports Med. 1987;15:225–229.
- Martinek V, Latterman C, Usas A, et al. Enhancement of tendon-bone integration of anterior cruciate ligament grafts with bone morphoge-netic protein-2 gene transfer: A histological and biomechanical study. J Bone Joint Surg Am. 2002;84:1123–1131.
- Rodeo SA, Arnoczky SP, Torzilli PA, Hidaka C, Warren RF. Tendon-healing in a bone tunnel: A biomechanical and histological study in the dog. J Bone Joint Surg Am. 1993;75:1795–1803.
- Gibble J, Ness P. Fibrin glue: The perfect operative sealant? Transfusion. 1990;30:741–747.
- Hood AG, Hill AG, Reeder GD. Perioperative autologous sequestration. III: A new physiologic glue with wound healing properties. Proc Am Acad Cardiovasc Perfusion. 1993;14:126–130.
- Marx RE, Carlson ER, Eichstaedt RM, Schimmele SR, Strauss JE, Georgeff KR. Platelet-rich plasma: Growth factor enhancement for bone grafts. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998; 85:638–646.
- Silva A, Sampaio R. Anatomic ACL reconstruction: Does the platelet-rich plasma accelerate tendon healing? Knee Surg Sports Traumatol Arthrosc. 2009;17:676–682.
- Demirag B, Sarisozen B, Ozer O, Kaplan T, Ozturk C. Enhancement of tendon-bone healing of anterior cruciate ligament grafts by blockage of matrix metalloproteinases. J Bone Joint Surg Am. 2005;87:2401–2410.
- Kyung HS, Kim SY, Oh CW, Kim SJ. Tendon-to-bone tunnel healing in a rabbit model: The effect of periosteum augmentation at the ten-don-to-bone interface. Knee Surg Sports Traumatol Arthrosc. 2003;11:9–15.
- Silva A, Sampaio R, Pinto E. Femoral tunnel enlargement after anatomic ACL reconstruction: A biological problem? Knee Surg Sports Traumatol Arthrosc. 2010;18:1189–1194.
- Weiler A, Hoffmann RF, Stähelin AC, Bail HJ, Siepe CJ, Südkamp NP. Hamstring tendon fixation using interference screws: A biomechanical study in calftibial bone. Arthroscopy. 1998;14:29–37.
- Bachy M, Sherifi I, Zadegân F, Petrover D, Petite H, Hannouche D. Anterior cruciate ligament surgery in the rabbit. J Orthop Surg Res. 2013;19:8–27.
- Chih-Hwa Chen. Strategies to enhance tendon graft-bone healing in Anterior Cruciate Ligament reconstruction. Chang Gung Med J. 2009;32:483–493.
- Yamazaki S, Yasuda K, Tomita F, Tohyama H, Minami A. The effect of transforming growth factor-beta1 on intraosseous healing of flexor ten-don autograft replacement of anterior cruciate ligament in dogs. Arthroscopy. 2005;21:1034–1041.
- Gulotta LV, Kovacevic D, Ying L, Ehteshami JR, Montgomery S, Rodeo SA. Augmentation of tendon-to bone healing with a magnesium-based bone adhesive. Am J Sports Med. 2008;36, 1290–1297.
- Rodeo SA, Suzuki K, Deng XH, Wozney J, Warren RF. Use of recombinant human bone morphogenetic protein-2 to enhance tendon healing in a bone tunnel. Am J Sports Med. 1999;27:476–488.
- Walsh WR, Stephens P, Vizesi F, Bruce W, Huckle J, Yu Y. Effects of low-intensity pulsed ultrasound on tendon bone healing in an in-tra-articular sheep knee model. Arthroscopy. 2007;23:197–204.
- Wang CJ, Wang FS, Yang KD, Weng LH, Sun YC, Yang YJ. The effect of shock wave treatment at the tendonbone inter-face: A histomorphological and biomechanical study in rabbits. J Orthop Res. 2005;23:274–280.
- Chen CH, Chen WJ, Shih CH. Enveloping of periosteum on the tendon graft to enhance tendon-bone healing in a bone tunnel: A biomechanical and histological studies in rabbits. Arthroscopy. 2003;19:290–296.
- Chen CH, Chen LH, Chen WJ, et al. Periosteum-enveloping of the tendon to enhance tendon-bone healing in the bone tunnel: Histologic studies in three experimental rabbit models. J Orthop Surg Taiwan. 2003;20:21–29.
- Chen CH, Liu HW, Tsai CL, Yu CM, Lin IH, Hsiue GH. Photoencapsulation of bone morphogenetic protein-2 and Periosteal progenitor cells improve tendon graft healing in a bone tunnel. Am J Sports Med. 2008;36:461–473.
- Chen CH, Liu HW, Hsiue GH, Tsai CL, Yu CM, Lin IH. Photoencapsulation of bone morphogenetic protein-2 and Periosteal progenitor cells enhance tendon-bone healing in anterior cruciate ligament reconstruction. Trans Orthop Res Soc. 2008;33:255.
- Cieślik-Bielecka A, Bielecki T, Gaździk TS, Arendt J, Król W, Szczepański T. Autologous platelets and leukocytes can improve healing of in-fected high-energy soft tissue injury. Transfus Apher Sci. 2009;41:9–12.
- Clark RA. Fibrin and Wound Healing. Ann N Y Acad Sci. 2001;936:355–367.
- Whitman DH, Berry RL, Green DM. Platelet gel: An autologous alternative to fibrin glue with applications in oral and maxillofacial surgery. J Oral Maxillofac Surg. 1997;55:1294–1299.
- Mishra A, Woodall J Jr, Vieira A. Treatment of tendon and muscle using platelet-rich plasma. Clin Sports Med. 2009;28:113–125.
- Rick GS, Craig JG, Mark SC. Platelet-rich plasma: Properties and clinical applications. J Lancaster Gen Hosp. 2007;2:73–77.
- Ganio C, Tenewitz FE, Wilson RC, Maules BG. The treatment of chronic nonhealing wounds using autologous platelet-derived growth factors. J Foot Ankle Surg. 1993;32:263–268.
- Paoloni J, De Vos RJ, Hamilton B, Murrell GA, Orchard J. Platelet-rich plasma treatment for ligament and tendon injuries. Clin J Sport Med. 2011;21:37–45.
- Schmidt CC, Georgescu HI, Kwoh CK, et al. Effect of growth factors on the proliferation of fibroblasts from the medial collateral and anterior cruciate ligaments. J Orthop Res. 1995;13:184–190.
- Yoshida M, Fuji K. Differences in cellular properties and responses to growth factors between human ACL and MCL cells. J Orthop Sci. 1999;4:293–298.
- Vogrin M, Rupreht M, Dinevski D, et al. Effects of a platelet gel on early graft revascularization after anterior cruciate ligament reconstruc-tion: A prospective, randomized, double-blind, clinical trial. Eur Surg Res. 2010;45:77–85.
- Browning SR, Weiser AM, Woolf N, et al. Platelet-rich plasma increases matrix metalloproteinases in cultures of human synovial fibroblasts. J Bone Joint Surg Am. 2012;5:1721–1727.