Monday, May 27, 2013

Platelet-rich plasma - does it help healing?

Patellar tendon healing with platelet-rich plasma: a prospective randomized controlled trial.

The authors proposed to test the hypothesis that adding PRP to the patellar tendon harvest site would improve donor site healing and improve clinical outcome at 6 months after anterior cruciate ligament reconstruction with a patellar tendon graft. They randomly divided 27 patients to receive or not receive PRP in the patellar tendon harvest site during ACL reconstruction. The primary outcome was magnetic resonance imaging assessment of 'patellar tendon healing' (gap area) after 6 months. Secondary outcomes were questionnaires and isokinetic testing of ACL reconstruction with a patellar tendon graft comparing both groups.

They found that patellar tendon gap area was smaller in the PRP group (4.9 ± 5.3 mm(2);  than in the control group (9.4 ± 4.4 mm(2);  P = .046).  There were no differences after 6 months in questionnaire and isokinetic testing results comparing both groups.

The authors concluded that PRP had a positive effect on patellar tendon harvest site healing on MRI after 6 months.

Comment: There is much interest in “PRP” as an agent to accelerate and enhance healing. There is also great commercial interest in this “biologic” therapy. In this study the authors randomized the harvest site of bone-patellar-bone graft taken for ACL reconstruction into one group receiving 20-40 mL of PRP gel and the other group receiving nothing. The MRI’s showed a marginally significant decrease in ‘gap area’ by MRI but no difference in cross sectional area. The authors concluded that “the addition of platelet-rich plasma to the patellar tendon harvest site improved tissue-healing at the patellar tendon donor site.” There was no difference in knee function scores or in the isokinetic testing results. 

Taken as presented, there was no apparent functional benefit of the PRP. Furthermore, it is unclear that the reduced ‘gap area’ represented improved healing, or instead a filling in of the MRI defect with non-functional reactive tissue in response to the gel: the controls did not include a gel without PRP.

Once again, we have the value question: from the data presented, it is not clear that the cost of PRP is justified by the benefit.
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