Open AccessIncreased platelet concentration does not improve functional graft healing in bio‐enhanced ACL reconstruction
Author(s) -
Fleming Braden C.,
Proffen Benedikt L.,
Vavken Patrick,
Shalvoy Matthew R.,
Machan Jason T.,
Murray Martha M.
Publication year - 2015
Publication title -
knee surgery, sports traumatology, arthroscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.806
H-Index - 125
eISSN - 1433-7347
pISSN - 0942-2056
DOI - 10.1007/s00167-014-2932-6
Subject(s) - anterior cruciate ligament , platelet rich plasma , extracellular matrix , cartilage , medicine , anterior cruciate ligament reconstruction , platelet , biomedical engineering , surgery , chemistry , anatomy , biochemistry
Purpose The use of an extracellular matrix scaffold (ECM) combined with platelets to enhance healing of an anterior cruciate ligament (ACL) graft (“bio‐enhanced ACL reconstruction”) has shown promise in animal models. However, the effects of platelet concentration on graft healing remain unknown. The objectives of this study were to determine whether increasing the platelet concentration in the ECM scaffold would (1) improve the graft biomechanical properties and (2) decrease cartilage damage after surgery. Methods Fifty‐five adolescent minipigs were randomized to five treatment groups: untreated ACL transection ( n = 10), conventional ACL reconstruction ( n = 15) and bio‐enhanced ACL reconstruction using 1× ( n = 10), 3× ( n = 10) or 5× ( n = 10) platelet‐rich plasma. The graft biomechanical properties, anteroposterior (AP) knee laxity, graft histology and macroscopic cartilage integrity were measured at 15 weeks. Results The mean linear stiffness of the bio‐enhanced ACL reconstruction procedure using the 1× preparation was significantly greater than traditional reconstruction, while the 3× and 5× preparations were not. The failure loads of all the ACL‐reconstructed groups were equivalent but significantly greater than untreated ACL transection. There were no significant differences in the Ligament Maturity Index or AP laxity between reconstructed knees. Macroscopic cartilage damage was relatively minor, though significantly less when the ECM‐platelet composite was used. Conclusions Only the 1× platelet concentration improved healing over traditional ACL reconstruction. Increasing the platelet concentration from 1× to 5× in the ECM scaffold did not further improve the graft mechanical properties. The use of an ECM‐platelet composite decreased the amount of cartilage damage seen after ACL surgery.