Effectiveness of ultrasound guided platelet rich plasma injection in comparison with standard conservative treatment on improving pain and function among the athletes with partial anterior cruciate ligament injury of knee: a randomized controlled trial
Keywords:ACL, PRP, IKDC score, VAS, Lysholm score, USG guided
Background: Anterior cruciate ligament (ACL) injuries are one of the most common ligamentous injuries of knee. Treatment options for partial ACL tear range from conservative treatment up to partial reconstruction. PRP may have enhancing effect on ACL cell viability and promotion of cell proliferation in partial tear of ACL. Thus, the purpose of this study is to determine the role of PRP on partial ACL tear.
Methods: A RCT was done among athletes with partial ACL injury who visited department of Sports Medicine, RIMS, Imphal during June 2019-December 2020. Patients with MRI diagnosed grade 1 and 2 ACL injury (n=48) randomized into PRP injection plus rehabilitation, (n=24) and rehabilitation alone, (n=24) groups. The outcomes were compared using International Knee Documentation Committee (IKDC) score, Lysholm score and VAS at baseline, 1st month, 4th month, 8th month and 12th month respectively.
Results: Baseline characteristics were not statistically significant. At the end of 1st month, there were statistically significant improvement in both mean difference of IKDC score (.001), Lysholm score (0.001) and VAS (0.007). At the end of 4th month, there were statistically significant improvement in both mean difference of IKDC score (0.001), Lysholm score (0.026) and VAS (0.001). At the end of 8th and 12th month, improvement in mean difference of IKDC score, Lysholm score, VAS were observed however not statistically significant.
Conclusions: Ultrasound guided PRP injection along with conservative rehabilitation program might be a treatment choice for ACL partial tear.
Yu B, Garrett WE. Mechanisms of non-contact ACL injuries. Br J Sports Med. 2007;41(1):i47-51.
You CK, Chou CL, Wu WT, Hsu YC. Nonoperative choice of anterior cruciate ligament partial tear: Ultrasound-guided platelet-rich plasma injection. J Med Ultrasound. 2019;27:148-50.
Zicaro ZP, Mansilla IG, Zuain A, Yacuzzi C, Paz MC. Has platelet-rich plasma any role in partial tears of the anterior cruciate ligament? Prospective comparative study. World J Orthop. 2021;12(6):423-32.
Hunt ER, Parise CN, and Butterfield TA. Alterations in Quadriceps Neurologic Complexity After Anterior Cruciate Ligament Reconstruction. JSR. 2021;29(7):1032-37.
Koch M, Mayr F, Achenbach L, Krutsch W, Lang S, Hilber F et al. BioMed Res. Int.2018;2018(1):1-9.
Dallo I, Chahla J, Mitchell JJ, Pascual-Garrido C, Feagin JA, LaPrade RF. Biologic Approaches for the Treatment of Partial Tears of the Anterior Cruciate Ligament: A Current Concepts Review. Orthop J Sports Med. 2017;5(1):1-9.
Seijas R, Ares O, Cuscó X, Álvarez P, Steinbacher G, Cugat R. Partial anterior cruciate ligament tears treated with intraligamentary plasma rich in growth factors. World J Orthop. 2014;5(3):373-8.
Zicaro JP, Yacuzzi C, Garcia-Mansilla I, Costa-Paz M. Nonsurgical treatment of partial ACL tears: intraarticular injection of Platelet-rich plasma did not change the progression rate to knee instability. Orthop J Sports Med. 2018;6(12):1-2.
Kumar S, Singh K, Chadha G. Comparative study of anterior cruciate ligament reconstruction versus conservative treatment among non-athletes: A 10-years follow-up. J Orthop Trauma Surg Rel Res. 2018;13(1):46-50.
Brukner P, Khan K. Clinical Sports Medicine 5th ed. Australia: McGraw-Hill Education; 2017.
Anitua E, Andia I, Ardanza B, Nurden P, Nurden AT. Autologous platelets as a source of proteins for healing and tissue regeneration. Thromb Haemost. 2004;91(1):4-15.
Steadman JR, Rodkey WG. Role of primary anterior cruciate ligament repair with or without augmentation. Clin Sports Med. 1993;12(1):685-95.
Centeno C, Markle J, Dodson E. Symptomatic anterior cruciate ligament tears treated with percutaneous injection of autologous bone marrow concentrate and platelet products: a non-controlled registry study. J Transl Med. 2018;16(246):1-13.
Li Y, Fu SC, Cheuk YC, Ong TY, Feng H, Yung SH. The effect of thermosensitive hydrogel platelet-rich-plasma complex in the treatment of partial tear of anterior cruciate ligament in rat model. J Orthop Translat. 2020;24:183-9.