The use of platelet-rich plasma (PRP) as an adjuvant
to tissue repair is gaining favour in orthopaedic surgery. Tunnel widening
after anterior cruciate ligament (ACL) reconstruction is a recognised
phenomenon that could compromise revision surgery. The purpose of
this study was to determine whether PRP might prevent tunnel widening
in ACL reconstruction. Patients undergoing ACL reconstruction using a hamstring graft
were randomly allocated either to have PRP introduced into the tunnels
peri-operatively or not. CT scanning of the knees was carried out
on the day after surgery and at three months post-operatively and
the width of the tunnels was measured. Patients were also evaluated
clinically at three months, when laxity was also measured. Each group comprised 25 patients, and at three months post-operatively
all were pain-free with stable knees, a negative Lachman test and
a good range of movement. Arthrometric results had improved significantly
in both groups (p <
0.001). Despite slightly less tunnel widening
in the PRP group, there was no significant difference between the
groups at the femoral opening or the mid-tunnel (p = 0.370 and p
= 0.363, respectively) nor at the tibial opening or mid-tunnel (p
= 0.333 and p = 0.177, respectively). We conclude that PRP has no significant effect in preventing
tunnel widening after ACL reconstruction. Cite this article:
Background: Several approaches to the ACL attachment and drilling methods exist, with little evidence of which method is the best. Hypothesis: The “Retrodrill” or an “inside-out” drilling technique result in uniform intra-articular tunnel mouths compared with standard “outside-in” conventional ACL drill bits. Study Design: Controlled laboratory study. Methods: Sixteen cadaveric knees were divided into Anterograde (A) and retrograde “Retrodrill” (R) groups and ACL tunnels drilled. The femoral tunnel mouths were moulded using PMMA, then Nylon rods of identical diameter containing 1mm diameter K-wires were inserted into the tunnels and AP and lateral X-rays taken. Matching laboratory experiments utilised 10 pig femurs and synthetic bone. Results: In group A, the mean difference between tunnels and their mouths was 1.6±0.5mm, compared with 0.3±0.2mm for Group R (p <
0.001). The mean femoral tunnel angulation in the sagittal plane for Group A was 45±10 degrees and 78±14 degrees for Group R (p<
0.001); and 30±12 degrees, and 71±12 degrees (p<
0.001) in the coronal plane respectively. There were similar ACL attachment hit rates from the groups. In porcine
