The Potentially Positive Role of PRPs in Preventing Femoral Tunnel Widening in ACL Reconstruction Surgery Using Hamstrings: A Clinical Study in 51 Patients
Purpose. In this study, the early and midterm clinical and radiological results of the anterior cruciate ligament (ACL) reconstruction surgery with or without the use of platelet rich plasma (PRP) focusing on the tunnel-widening phenomenon are evaluated. Methods. This is a double blind, prospective randomized study. 51 patients have completed the assigned protocol. Recruited individuals were divided into two groups: a group with and a group without the use of PRPs. Patients were assessed on the basis of MRI scans, which were performed early postoperatively and repeated at least one-year postoperatively. The diameter was measured at the entrance, at the bottom, and at the mid distance of the femoral tunnel. Results. Our study confirmed the existence of tunnel widening as a phenomenon. The morphology of the dilated tunnels was conical in both groups. There was a statistical significant difference in the mid distance of the tunnels between the two groups. This finding may support the role of a biologic response secondary to mechanical triggers. Conclusions. The use of RPRs in ACL reconstruction surgery remains a safe option that could potentially eliminate the biologic triggers of tunnel enlargement. The role of mechanical factors, however, remains important. 1. Introduction Following a successful ligament reconstruction, what matters most both for the surgeon and for the patient is the fast and durable integration of the graft. This practically means a rapid and permanent return in patients’ high-level activities. And if time is not the priority, the quality of the graft integration is what everybody asks for. Tunnel widening or tunnel enlargement is a previously unrecognized phenomenon associated with ACL reconstruction, which is referred to in the literature over the last two decades [1–7]. The clinical relevance of the phenomenon has been questioned [1, 3, 6, 8] but there are studies that consider this an important complication [9] making revision surgery problematic [10–13]. Several studies, in the past, have evaluated the importance of the various types of grafts [14, 15], reconstruction or fixation methods [16–24], and rehabilitation protocols [25, 26] but only recently surgeons have started to use blood material to biologically enhance graft integration [12, 27–30]. This study compared the early and midterm clinical and radiological results of the Anterior Cruciate Ligament (ACL) reconstruction surgery with or without the use of platelet rich plasma (PRP) focusing on the tunnel-widening phenomenon. The purpose of the study was to investigate the
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