THE EFFECT OF PLASMA PREPARATION RICH IN GROWTH FACTORS ON PATELLAR STABILITY AFTER MEDIAL PATELLOFEMORAL LIGAMENT REEFING
Introduction: Although more than 100 operative procedures have been described for the treatment of patellar instability, there is no single universally successful procedure. For the most patients with lateral patellar instability medial patellofemoral ligament (MPFL) reefing is recommended. When we perform MPFL reefing we are not aware of the quality and strength of the MPFL tissue. In the presence of recurrent patellar instability,the quality and strength of MPFL tissue is often compromised and it disturbs patellar stability after MPFL reefing. Biomedicine development,recognizing the ligament healing process show us that autologous blood products, particularly PRP can enhance healing in soft tissue injuries.
Purpose: The purpose of this study was to determine the potential effect of Plasma preparation rich in growth factorson patellar stability after MPFL reefing.
Material and methods: Plasma preparationrich in growth factors was produced from a unit of autologous whole blood using Arthrex ACP double syringe system.Platelet gel was prepared by adding bovine thrombin and 10% solution of calcium chloride.The platelet gel was applied locally into the place where suturing of the MPFL was performed. In this prospective, randomized and double blindstudy12 patients were included:6 patients in the PG group who received platelet gel and 6 patients in the control group who were not treated with platelet gel. Patellar stability was evaluated before surgery and 3 months after surgery with Axial stress radiographs.
Results: The calculated 3 month improvement was 12.67 2.51 in the control group and 17.33 1.52 in the PG group, (p=0.064).Although there was greater improvement in patellar stability in PG group comparing to the control group, the difference was not statistically significant (p>0.05).The main reason for this was probably the small number of patients included in the study.
Conclusion: Results showed that growth factors from the plasma preparation rich in growth factorshave positive effect on patellar stability after MPFL reefing.We believe that they stimulate and accelerate physiological healing and reparative tissue processes in ligament healing. More studies should be made, including more patients, if we want to get more relevant results.
Hautamaa PV, Fithian DC, Kaufman KR, Daniel DM, Pohlmeyer AM. Medial soft tissue restraints in lateral patellar instability and repair. Clin Orthop Relat Res. 1998;349:174–82.
Tom A, Fulkerson P. Restoration of native medial patellofemoral ligament support after patella dislocation. Sports Med. Arthroscopy. 2007;15(2):68-71.
Schepsis A, Rogers AJ. Medial patellofemoral ligament reconstruction: indications and technique. Sports Med Arthrosc. 2012; 20(3):162-70.
Middleton KK, Barro V, Muller B, Terada S, Fu FH. Evaluation of the effects of platelet-rich plasma (PRP) Therapy involved in the healing of sports-related soft tissue injuries. Iowa Orthop J. 2012; 32:150–63.
Marx RE. Platelet-rich plasma (PRP): What is PRP and whatis not PRP? Implant Dent.2001;10(4):225-8.
Marx RE. Platelet-rich plasma: Evidence to support its use.J. Oral Maxillofac. Surg. 2004;62(4):489-96.
Everts AP, Knape JT, Weibrich G, et al. Platelet-Rich Plasma and Platelet Gel: A Review. J Extra Corpor Technol. 2006;38(2):174–87.
Gonshor A. Technique for producing platelet-rich plasma and platelet concentrate: Background and process. Int. J. Periodontics Restorative Dent. 2002;22(6):547-57.
Petrungaro PS. Using platelet-rich plasma to accelerate soft tissue maturation in esthetic periodontal surgery. Compend. Contin. Educ. Dent.2001;22(9):729-32.
Yoshioka T, Kanamori A, Washio T, et all. The effects of plasma rich in growth factors (PRGF-Endoret) on healing of medial collateral ligament of the knee. Knee Surg Sports Traumatol Arthrosc. 2013;21(8):1763-9.
Andriolo L. Di Matteo B, Kon E, Filardo G, Venieri G, Marcacci M. PRP Augmentation for ACL Reconstruction. Bio Med Res Int. 2015;2015:371746. doi: 10.1155/2015/371746.
Cervellin M. de Girolamo L, Bait C, Denti M, Volpi P. Autologous platelet-rich plasma gel to reduce donor-site morbidity after patellar tendon graft harvesting for anterior cruciate ligament reconstruction: a randomized, controlled clinical study. Knee Surg. Sports Traumatol. Arthrosc. 2012; 20(1):114-20.
Gobbi A, Karnatzikos G, Mahajan V, Malchira S. Platelet-rich plasma treatment in symptomatic patients with knee osteoarthritis: preliminary results in a group of active patients. Sports Health. 2012;4(2):162-72.
Lopez-Gavito E. Gomez-Carlín LA, Parra-Tellez P, Vazquez-Escamilla J. Platelet-rich plasma for managing calcaneus tendon tendinopathy and plantar fasciitis. Acta Orthop Mex. 2011;25(6):380-5.
Chaudhury S, de La Lama M, Adler RS, et all. Platelet-rich plasma for the treatment of lateral epicondylitis: sonographic assessment of tendon morphology and vascularity (pilot study).Skeletal Radiol. 2013;42(1):91-7.
Gosens T, Peerbooms JC, van Laar W, den Oudsten BL. Ongoing positive effect of platelet-rich plasma versus corticosteroid injection in lateral epicondylitis: A double-blind randomized controlled trial with 2-year follow-up. Am J Sports Med. 2011; 39(6):1200-8.
Hechtman KS, Uribe JW, Botto-van Demden A, Kiebzak GM. Platelet-rich plasma injection reduces pain in patients with recalcitrant epicondylitis. Orthopedics. 2011;34(2):92.
Filardo G, Kon E, Della Villa S, Vincentelli F, Fornasari PM, Marcacci M. Use of platelet-rich plasma for the treatment of refractory jumper’s knee. IntOrthop. 2010;34(6):909-15.
Kon E, Filardo G, Delcogliano M, et al. Platelet-rich plasma: New clinical application: A pilot study for treatment of jumper’s knee. Injury. 2009;40(6):598-603.
Laurin CA, Dussault R, Levesqu HP.The tangential x-ray investigation of patellofemoral joint: x-ray technique, diagnostic criteria, and their interpretation. Clin Orthop Relat Res. 1979;144:16-26.
Halbrecht JL. Arthroscopic patella realignment: An all-inside technique. Arthroscopy. 2001;17(9):940-5.
Anderson, JM. The cellular cascades of wound healing. In:Davies JE, Editor. Bone Engineering. Toronto: em squared inc.,2000: p.81–93.
Buckwalter JA, Einhorn TA, Bolander ME. Healing of musculoskeletal tissues. In: Rockwood CA, Bucholz RW Jr, Green DP, Eds., Fractures in Adults. Philadelphia: Lippincott Raven, 1996: p. 261–304.
Kevy SV, Jacobson MS. Comparison of methods forpoint of care preparation of autologous platelet gel. J. Extra Corpor. Technol. 2004;36(1):28-35.
Waters JH, Roberts KC. Database review of possiblefactors influencing point-of-care platelet gel manufacture. J Extra Corpor Technol. 2004;36(3):250-4.
Weibrich G, Kleis WK, Hafner G, Hitzler WE Growth factor levels in platelet-rich plasma and correlations with donor age, sex, and platelet count. J Craniomaxillofac Surg.2002;30(2): 97-102.
Dzoleva-Tolevska R, Poposka A, Georgieva D, Bozinovski Z, Nanceva J, Gjoshev S. Comparative analyses of diagnostic methods in knee injuries. Sanamed. 2016; 11(1):39-45.
- There are currently no refbacks.
Copyright (c) 2016 SANAMED
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.