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Intraarticular application of autologous conditioned serum (ACS) reduces bone tunnel widening after ACL reconstructive surgery in a randomized controlled trial

Knee Surgery, Sports Traumatology, Arthroscopy volume 19, pages 36–46 (2011)Cite this article

A Correction to this article was published on 22 October 2018

Abstract

Purpose

Pro-inflammatory cytokines play a pivotal role in osteoarthritis, as well as in bone tunnel widening after ACL reconstructive surgery. A new treatment option is to administer autologous conditioned serum (ACS) containing endogenous anti-inflammatory cytokines including IL-1Ra and growth factors (IGF-1, PDGF, and TGF-β1, among others) in the liquid blood phase. The purpose of this trial was to establish whether the postoperative outcome could be affected by intraarticular application of ACS.

Methods

In a prospective, randomized, double-blinded, placebo-controlled trial with two parallel groups, 62 patients were treated. Bone tunnel width was measured by CT scans, while clinical efficacy was assessed by patient-administered outcome instruments (WOMAC, IKDC 2000) up to 1 year following the ACL reconstruction in patients receiving either ACS (Group A) or placebo (Group B). We compared the levels and dynamics of IL-1β concentrations in the synovial liquid and examined the correlation between the levels of IL-1β at three different postoperative points.

Results

Bone tunnel enlargement was significantly less (6 months: 8%, 12 months: 13%) in Group A than in Group B (6 months: 31%, 12 months: 38%). Clinical outcomes (WOMAC, IKDC 2000) were consistently better in patients treated with ACS at all data points and for all outcome parameters, and there were statistically significant differences in the WOMAC stiffness subscale after 1 year. The decrease in IL-1β synovial fluid concentration was more pronounced in the ACS group, and values were lower, to a statistically significant degree, in the ACS group at day 10.

Conclusion

The intraarticular administration/injection of ACS results in decreased bone tunnel widening after ACL reconstructive surgery.

Level of evidence

Therapeutic study, Randomized controlled trial (significant differences and narrow confidence intervals), Level I.

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Acknowledgments

The trial was an investigator-initiated, prospective, double-blind, reference-controlled study. The source of all funding for the study has been obtained by the National Health Insurance. We thank Vera Srsan Zivanovic (Department of General Surgery and Traumatology, General Hospital Varazdin), Renata Jug (Institute of Imunology, Zagreb), Damir Poljak (Department of Transfusiology, General Hospital Varazdin), and Darko Kranjcec (Department of General Surgery and Traumatology, General Hospital Varazdin).

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. University Clinic for Traumatology, Medical School, University of Zagreb, Draskoviceva 19, 10000, Zagreb, Croatia

    Nikica Darabos & Dubravka Bartolek

  2. Special Hospital for Orthopaedics and Traumatology Akromion, Ljudevita Gaja 2, 49 217, Krapinske Toplice, Croatia

    Miroslav Haspl

  3. Groenemeyer Institute for Microtherapy, University Witten-Herdecke, Universitaetsstrasse 142, 44799, Bochum, Germany

    Carsten Moser & Dietrich Groenemeyer

  4. Scientific Unit, General Hospital Varazdin, Mestroviceva 1, 42000, Varazdin, Croatia

    Anela Darabos

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  1. Nikica Darabos
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Correspondence to Nikica Darabos.

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Darabos, N., Haspl, M., Moser, C. et al. Intraarticular application of autologous conditioned serum (ACS) reduces bone tunnel widening after ACL reconstructive surgery in a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 19 (Suppl 1), 36–46 (2011). https://doi.org/10.1007/s00167-011-1458-4

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Keywords

  • ACL reconstruction
  • Autologous conditioned serum
  • ACS
  • Osteoarthritis
  • Interleukin-1 receptor antagonist (IL-1Ra)
  • Growth factors