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: Bone Joint J 2013;95-B:65–9.

Introduction and Objective. Platelet-Rich-plasma (PRP) has been used in combination with stem cells, from different sources, with encouraging results both in vitro and in vivo in osteochondral defects management. Adipose-derived Stem Cells (ADSCs) represents an ideal resource for their ease of isolation, abundance, proliferation and differentiation properties into different cell lineages. Furthermore, Stem Cells in the adipose tissue are more numerous than from other sources. Aim of this study was to evaluate the potential of ADSCs in enhancing the effect of arthroscopic mesenchymal stimulation combined with infiltration of PRP. Materials and Methods. The study includes 82 patients. 41 patients were treated with knee arthroscopy, Steadman microfractures technique and intraoperative PRP infiltration, Group A. In the Group B, 41 patients were treated knee arthroscopy, Steadman microfractures and intraoperative infiltration of PRP and ADSCs (Group B). Group A was used as a control group. Inclusion criteria were: Age between 40 and 65 years, Outerbridge grade III-IV chondral lesions, Kellegren-Lawrence Grade I-II. Patient-reported outcome measures (PROMs) evaluated with KOOS, IKDC, VAS, SF-12 were assessed pre-operatively and at 3 weeks, 6 months, 1-year post-operative. 2 patients of Group A and 3 patients of Group B, with indication of Puddu plate removal after high tibial osteotomy (HTO), underwent an arthroscopic second look, after specific informed consent obtained. On this occasion, a bioptic sample was taken from the repair tissue of the chondral lesion previously treated with Steadman microfractures. Results. PROMs showed statistically significant improvement (p <0.05) with comparable results in both groups. The histological examination of the bioptic samples in Group B showed a repair tissue similar to hyaline cartilage, according to the International Cartilage Repair Society (ICRS) Visual Histological Assessment Scale. In Group A, the repair tissue was fibrocartilaginous. Conclusions. According to the PROMs and the histological results, showing repair tissue after Steadman microfractures qualitatively similar to hyaline cartilage, the combination of ADSCs and PRP could represent an excellent support to the arthroscopic treatment of focal chondral lesions and mild to moderate osteoarthritis

OBJECTIVE: The purpose of this study is to examine the effect of a single percutaneous injection of platelet-rich-plasma compared to an injection of corticosteroids in patients with chronic lateral epicondylitis. BACKGROUND: Lateral epicondylitis is a common problem that usually resolves with nonoperative treatments. Platelet Rich Plasma (PRP) is a component of whole blood that contains concentrated amounts of powerful growth factors. PRP has been used for a variety of orthopedic applications including tendinopathy, wound healing and spinal fusion with varying degrees of success. Buffered PRP has also been used to enhance cell proliferation in-vitro. HYPOTHESIS: Treatment of chronic severe lateral epicondylitis with buffered platelet-rich plasma will reduce pain and increase function in patients considering surgery for their problem. METHODS: One hundred patients with persistent lateral epicondylar pain were evaluated in this study. All these patients were initially given a variety of nonoperative treatments. These patients had significant persistent pain for at least 3 months despite these interventions. All patients were considering surgery. This cohort of patients who had failed nonoperative treatment was then given either a single percutaneous injection of platelet-rich plasma (experimental group, n = 50) or corticosteroids (control group, n = 50). RESULTS: PRP has a significant better effect on lateral epicondylitis than corticosteroid injections. CONCLUSION: This in-vivo data suggest that tendon healing is occurring in lateral epicondylitis using PRP

We present the results of a single percutaneous injection of platelet-rich-plasma (PRP) to lateral epicondyle in patients with severe chronic lateral elbow epicondylitis(ELE). Between 2006–2008 eight patients suffered from severe chronic ELE. They had severe persistent pain (mean 85, range 70–100 on a Visual Analogue Pain scale(VAS)) despite conservative methods at least one year. Three patients were men and five were women with age from 38–63 years (mean 44). Right elbow was the involved in six patients, left elbow in one and the last patient had bilateral ELE. All patients underwent a single percutaneous injection of PRP (located to lateral epicondyle using a specific technique). PRP is derived from centrifugation of 27–30 ml autologous blood using the GPS system. After the injection of PRP all patients underwent a 2-week standardized stretching protocol and then a strengthening program for four weeks. The results estimated with a 100-mm VAS (0 no pain, 100 the worst pain) and a modified Mayo Elbow Performance Score (MEPS). The patients examinated four, eight and twenty four weeks after the injection and also at the last follow-up (mean 28, range from 16 to 38 months). There were no regional or systemic complications. Four weeks after treatment the patients reported improvement in VAS mean score from 85 to 40 and in MEPS from 51 to 75. Eight weeks after injection the VAS mean score improved from 85 to 22 and the MEPS from 51 to 82. At six months the VAS score was 10 (mean) and the MEPS 90. Finally at the last follow-up the mean VAS score was 7 and the MEPS 92. The percutaneous injection of PRP to lateral epicondyle in patients with severe chronic ELE seems to lead in a significant reduction of their pain and improvement of their elbow function. These good results may sustain over time

Introduction: Activated platelets release various growth factors, some ot which are recognize to improve nerve regeneration. The present study evaluated the effect of platelet-rich-plasma (PRP) in end to end neurorraphy. Material and method: A total of 38 Spragle-Dawley rats were used. The PRP was obteined from each rat and applicated to the same rat. The left hind limb were used as experimental, with the right as control. The animals were treated in two grups. In both groups the sciatic nerve was dissected from the sciatic notch to the bifurcation. The nerve was transected an repaired with epineural suture (ethilon 9–0). Group A (n=12): suture without PRP. Group B (n=15) suture with PRP. The rats were anestherized and electromyographic studie was performed after the following, 120,5 days for group A and 125,86 for group B. Prior to sacrifice muscular and nerve tissue harvesting was performed. The amplitude was expressed as the amplitude at the experimental sde divided by the amplitude at the contralateral, untreated side, multiplied by 100%. Recording was done in gastrocnemius and tibialis anterior muscle. Results: The stimulation was performed in supramaximal form on both groups: Group A: (without PRP). The mean of intensity was 1.49 mA and the mean of threshold was 0,56 mA. The mean of amplitude was 19,53mV for tibialis anterior and 42,83 mV for gastrocnemius. The mean of latency was 2,28ms for tibialis anterior and 2,19ms for gastrocnemius Group B: (with PRP). The mean of intensity was 1,46 mA and the mean of threshold was 0,53 mA. The mean of amplitude was 21,83mV for tibialis anterior and 19,32mV for gastrocnemius. The mean of latency was 2,43ms for tibialis anterior and 2,29ms for gastrocnemius. No stadistical difference on both groups was found. Histological studies were performed and results are no available at the moment of send this abstract. Conclusions:. No evidence has been found that the use of PRP has a beneficial effect on peripheral nerve regeneration. Further studies should be do to elucited the real role of PRP on peripheral nerve regeneration