MRI evaluation of tibial tunnel wall cortical bone formation after platelet-rich plasma gel applied during anterior cruciate ligament reconstruction
Background: After anterior cruciate ligament reconstruction, formation of cortical sclerotic bone encircling the femoral and tibial tunnel is a part of intratunnel graft healing. During the physiological cascades of soft tissue healing and bone growth, cellular and hormonal factors play an important role. The purpose of this study was to noninvasively but quantitatively assess the effect of intraoperatively applied platelet-rich plasma gel on the formation of cortical bone encircling the tibial tunnel.
Methods: In fifty patients, standard arthroscopic ACL reconstructions were performed. The PRPG group (n = 25) received a local application of PRPG while the control group (n = 25) did not receive PRPG. The proximal tibial tunnel was examined by MRI in the paraxial plane where the portion of the tibial tunnel wall circumference consisting of sclerotic cortical bone was assessed with testing occurring at one, two and a half and six months after surgery.
Results: At one month after surgery, differences between the groups in the amount of cortical sclerotic bone encircling the tunnel were not significant (p = 0.928). At two and a half months, the sclerotic portion of the tunnel wall in the PRPG group (36.2%) was significantly larger than in the control (22.5%) group (p=0.004). At six months, the portion of sclerotic bone in the PRPG group (67.1%) was also signifinactly larger than in the control (53.5%) group (p=0.003).
Conclusion: Enhanced cortical bone formation encircling the tibial tunnel at 2,5 and 6 months after ACL graft reconstruction results from locally applied platelet-rich plasma gel.