Biologically enhanced anterior cruciate ligament reconstruction: Platelet‐rich plasma or bone marrow aspirate concentrate does not lead to better clinical or radiological outcomes—A randomized controlled trial of 175 cases with 2 years of follow‐up
Akram Aldawoudy Mokhtar, Hesham Gawish, Ahmed Abdelgawad, Akram Deghady, Esraa Hassaan, Khaled Matarawy, Ahmed Amer, Eiman Soliman, Michael T. HirschmannAbstract
Purpose
To compare the clinical and radiological outcomes of anterior cruciate ligament reconstruction (ACLR) augmented with platelet‐rich plasma (PRP) (1) or bone marrow aspirate concentrate (BMAC) (2) against a control group undergoing standard ACLR without biological additives.
Methods
One hundred seventy‐five patients undergoing biologically enhanced ACLR using semitendinosus quadruple autograft were prospectively included in this randomized controlled trial. Patients were randomized to either the control group (no biological additives, n = 79) or ACLR plus application of PRP to the graft ( n = 53) or ACLR plus BMAC application to the graft ( n = 43). ACLR techniques were standardized for all patients, and all were performed by a senior surgeon. Biological additives were also standardized and prepared by a senior laboratory physician in the operating room. After an average of 2 years, patients were assessed clinically, and SI of the ACL graft was measured in the magnetic resonance imaging (MRI).
Results
There was no clinically significant difference in clinical outcomes (clinical examination [ p = 0.867] and patients' reported outcome scores, Lysholm [ p = 0.881], International Knee Documentation Committee [ p = 0.864] and Marx activity return to sport scale [ p = 0.666]). There was no significant difference in MRI SI of the intra‐articular graft or the graft inside the tunnels ( p = 0.898) after a mean of 2 years. Cases with BMAC addition to the graft showed poorer MRI SI.
Conclusion
Biological ACL reconstruction enhanced with PRP or BMAC did not reveal any statistically significant clinical or radiological results; on the contrary, BMAC application may lead to poorer MRI SI.
Level of Evidence
Level I, randomized controlled trial.