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Acute Achilles Tendon Repair of grafts in ACL reconstruction.22,23 Ⅲ PRP in the femoral tunnel
Sanchez et al20 investigated the use Orrego et al22 divided 108 ACL activated by thrombin.
of PRP to enhance the healing of reconstruction patients into At three months post-surgery,
surgically repaired Achilles tendon four groups:
ruptures. Six patients who were Ⅲ Reconstruction with hamstrings MRI scans were used to compare
treated with PRP intra-operatively the osteoligamentous zone (halo)
were compared to six control patients autograft (control group) with the signal of other structures of
treated with standard repair without Ⅲ Reconstruction with hamstrings the knee, (including patellar tendon,
PRP. Both groups underwent identical skeletal muscle, joint fluid, and
post-operative rehabilitation courses. autograft with PRP application synovial membrane). The authors
Functional outcomes studied included Ⅲ Reconstruction with hamstrings found no statistically significant
time to reach full range-of-motion, difference in graft signal intensity
time to gentle running, and time autograft with bone plug between the groups at three months,
to resume training activities. An Ⅲ Reconstruction with hamstrings and they noted that there were no
ultrasound examination to determine grafts with grade 0 signal (normal
the cross-sectional area of the repaired autograft with bone plug and patellar tendon, indicating highest
tendon was performed in all patients PRP application. graft maturation). Therefore, at three
at 30 to 50 months post-surgery. Clinical outcomes included months post-operation, there did
The authors reported that all three Lysholm and International Knee not appear to be any benefit with
functional outcomes were reached Documentation Committee scores. the use of PRP.
significantly faster in the PRP group. MRI scans at three and six months
Also, the cross-sectional area of the post-operation were used to look Use of PRP in Athletes
healed tendon was smaller in the for the following:
PRP group, perhaps indicating Ⅲ Graft signal intensity (high/low) Even if PRP is proven to be effective
greater remodeling in this group. Ⅲ Osteoligamentous interface in treating the above injuries, the next
This study was prospective and (halo around graft) big question is whether its use will be
had a control group, but was Ⅲ Tunnel widening (>2 mm). allowed in amateur and professional
limited by its small sample size. The authors found less tunnel athletes under the rules of antidoping
widening in the bone plug group agencies since PRP contains growth
Rotator Cuff Repair alone versus the other groups at factors (such as IGF-1 and mechano
Randelli et al21 evaluated 14 patients six months. In terms of graft signal growth factor,) which are prohibited
who had arthroscopic rotator intensity, there was no difference in by these agencies. In September 2009,
cuff repairs performed that were the groups at three months, but at the World Anti-Doping Agency met to
augmented with the intra-operative six months the PRP hamstring group discuss the use of PRP and determined
application of autologous PRP in had more grafts with lower signal, that PRP will be prohibited when
combination with an autologous indicating more mature grafts. In given via the intramuscular route, and
thrombin component after repair. terms of graft interface, there was that its use via other routes (i.e., local
Follow-up was at six, 12, and 24 no statistical difference between injections at the site of injury) will
months post-operation. The authors the groups. Similarly, there was require a declaration of use that is
reported that visual analog scores no difference in clinical outcomes. in compliance with the International
(VAS), UCLA scores, and Constant Therefore, except for potentially Standard for Therapeutic Use
scores all significantly improved improved graft maturation at six Exemptions (TUEs).3 Similarly,
at each time interval compared to months post-operation, there were the U.S. Anti-doping Agency issued
pre-surgery scores and that there no significant benefits with the an “athlete’s advisory” in April 2009
were no adverse events. However, use of PRP. that a PRP injection is equivalent to
there was no control group and no Silva et al23 also studied the effects an injection of growth factors and that
radiographic or ultrasonic follow-up of PRP on ACL reconstruction with an athlete needs a TUE if a medical
to assess for tendon healing. hamstrings autograft. Patients were professional determines that a PRP
randomized to one of the following injection is medically necessary.3
ACL Reconstruction four groups: These governing bodies, however, do
Two clinical studies have examined Ⅲ Control not have any jurisdiction over U.S.
the effect of PRP on the incorporation Ⅲ PRP in the femoral tunnel professional athletes; and, thus far,
Ⅲ PRP in the femoral tunnel with PRP is not specifically addressed in
an intra-articular injection of PRP
at 2 and 4 weeks post-surgery

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