Skip to main content
SpringerLink
Log in

Pain in donor site after BTB-ACL reconstruction with PRGF: a randomized trial

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Anterior cruciate ligament (ACL) tears are highly incident injuries in young athletes within our work area. The use of the patellar graft, despite being the treatment of choice, presents post-operative problems such as anterior knee pain, which limits its use and leads to preference being taken for alternative grafts. Our aim was to evaluate if the application of PRGF reduces anterior knee pain in donor site in BTB-ACL reconstruction.

Materials and Methods

43 patients were included in the double-blinded and randomized clinical trial comparing two patient groups who underwent ACL reconstruction using patellar tendon graft, comparing anterior knee pain with and without the application of PRGF at the donor site after harvesting the graft. Results: The PRGF group showed decreased donor site pain in comparison to the control group, with significant differences in the first two months of follow-up.

Conclusion

The application of PRGF decreased donor site pain compared to the control group.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Insall JN, Scott WN (2004) Surgery of the knee, 3rd ed. Philadelphia, USA, 600–50

  2. Franck CB, Jackson DW (1997) The science of reconstruction of the anterior cruciate ligament. J Bone Joint Surg Am 79(10):1556–1576

    Google Scholar 

  3. Beaufils P, Gaudot F, Drain O, Boisrenoult P, Pujol N (2011) Mini-invasive technique for bone patellar tendon bone harvesting: its superiority in reducing anterior knee pain following ACL reconstruction. Curr Rev Musculoskelet Med 4(2):45–51

    Article  PubMed  PubMed Central  Google Scholar 

  4. Shelbourne KD, Trumper RV (1997) Preventing anterior knee pain after anterior cruciate ligament reconstruction. Am J Sports Med 25(1):41–47

    Article  CAS  PubMed  Google Scholar 

  5. Seijas R, Cugat R (2010) Anterior cruciate ligament graft: bone-tendon-bone. Techniques in knee surgery. 9(4):209–215

    Article  Google Scholar 

  6. Seijas R, Rius M, Ares O, García-Balletbó M, Serra I, Cugat R (2015) Healing of donor site in bone-tendon-bone ACL reconstruction accelerated with plasma rich in growth factors: a randomized clinical trial. Knee Surg Sports Traumatol Arthrosc 23(4):991–997

    Article  PubMed  Google Scholar 

  7. Sanchez M, Anitua E, Cugat R, Azofra J, Guadilla J, Seijas R et al (2009) Nonunions treated with autologous preparation rich in growth factors. J Orthop Trauma 23(1):52–59

    Article  PubMed  Google Scholar 

  8. Sanchez-Gonzalez DJ, Mendez-Bolaina E, Trejo-Bahena NI (2012) Platelet-rich plasma peptides: key for regeneration. Int J Pept 2012:532519

    Article  PubMed  PubMed Central  Google Scholar 

  9. Orrego M, Larrain C, Rosales J, Valenzuela L, Matas J, Durruty J et al (2008) Effects of platelet concentrate and a bone plug on the healing of hamstring tendons in a bone tunnel. Arthroscopy 24(12):1373–1380

    Article  PubMed  Google Scholar 

  10. Radice F, Yanez R, Gutierrez V, Rosales J, Pinedo M, Coda S (2010) Comparison of magnetic resonance imaging findings in anterior cruciate ligament grafts with and without autologous platelet-derived growth factors. Arthroscopy 26(1):50–57

    Article  PubMed  Google Scholar 

  11. Seijas R, Ares O, Catala J, Alvarez-Diaz P, Cusco X, Cugat R (2013) Magnetic Resonance imaging evaluation of patellar tendon graft remodeling after anterior cruciate ligament reconstruction with or without platelet-rich plasma. J Orthop Surg (Hong Kong) 21(1):10–14

    Google Scholar 

  12. Fernandez-Sarmiento JA, Dominguez JM, Granados MM, Morgaz J, Navarrete J, Carrillo JM et al (2013) Histological study of the influence of plasma rich in growth factors (ORGF) on the healing of divided Achilles tendons in sheep. J Bone Joint Surg Am 95(3):246–255

    Article  PubMed  Google Scholar 

  13. Sánchez M, Anitua E, Azofra J, Andía I, Padilla S, Mujika I (2007) Comparison of surgically repaired Achilles tendon tears using platelet-rich fibrin matrices. Am J Sports Med 35(2):245–251

    Article  PubMed  Google Scholar 

  14. Anoka N, Nyland J, McGinnis M, Lee D, Doral MN, Caborn DN (2012) Consideration of growth factors and bio-scaffolds for treatment of combined grade II MCL and ACL injury. Knee Surg Sports Traumatol Arthrosc 20(5):878–888

    Article  PubMed  Google Scholar 

  15. De Almeida AM, Demange MK, Sobrado MF, Rodrigues MB, Pedrinelli A, Hernandez AJ (2012) Patellar tendon healing with platelet-rich plasma: a prospective randomized controlled trial. Am J Sports Med 40(6):1282–1288

    Article  PubMed  Google Scholar 

  16. Cervellin M, de Girolamo L, Bait C, Denti M, Volpi P (2012) Autologous platelet-rich plasma gel to reduce donor-site morbidity after patellar tendon graft harvesting for anterior cruciate ligament reconstruction: a randomized, controlled clinical study. Knee Surg Sports Traumatol Arthrosc 20(1):114–120

    Article  CAS  PubMed  Google Scholar 

  17. Lyras DN, Kazakos K, Verettas D, Polychronidis A, Tryfonidis M, Botaitis S et al (2009) The influence of platelet-rich plasma on angiogenesis during the early phase of tendon healing. Foot Ankle Int 30(11):1101–1106

    Article  PubMed  Google Scholar 

  18. Lyras DN, Kazakos K, Verettas D, Botaitis S, Agrogiannis G, Kokka A et al (2009) The effect of platelet-rich plasma gel in the early phase of patellar tendon healing. Arch Orthop Trauma Surg 129(11):1577–1582

    Article  PubMed  Google Scholar 

  19. Anitua E (1999) Plasma rich in growth factors: preliminary results of use in the preparation of sites for implants. Int J Oral Maxillofac Implants 14:529–535

    CAS  PubMed  Google Scholar 

  20. Sánchez M, Anitua E, Azofra J, Aguirre JJ, Andia I (2008) Intra-articular injection of an autologous preparation rich in growth factors for the treatment of knee OA: a retrospective cohort study. Clin Exp Rheumatol 26(5):910–913

    PubMed  Google Scholar 

  21. Kartus J, Magnusson L, Stener S, Brandsson S, Eriksson BI, Karlsson J (1999) Complications following arthroscopic anterior cruciate ligament reconstruction. A 2–5-year follow-up of 604 patients with special emphasis on anterior knee pain. Knee Surg Sports Traumatol Arthrosc 7(1):2–8

    Article  CAS  PubMed  Google Scholar 

  22. Kartus J, Movin T, Karlsson J (2001) Donor-site morbidity and anterior knee problems after anterior cruciate ligament reconstruction using autografts. Arthroscopy 17(9):971–980

    Article  CAS  PubMed  Google Scholar 

  23. Kohn D, Sander-Beuermann A (1994) Donor-site morbidity after harvest of a bonetendon-bone patellar tendon autograft. Knee Surg Sports Traumatol Arthrosc 2(4):219–223

    Article  CAS  PubMed  Google Scholar 

  24. Weiss RA, Re LP, Rintz KG (1993) Incidence of anterior knee pain after treatment for anterior cruciate ligament rupture. Arthroscopy 9(3):366–367

    Google Scholar 

  25. Flandry F, Hunt JP, Terry GC, Hughston JC (1991) Analysis of subjective knee complaints using visual analog scales. Am J Sports Med 19(2):112–118

    Article  CAS  PubMed  Google Scholar 

  26. Biau DJ, Katsahian S, Kartus J, Harilainen A, Feller JA, Sajovic M, Ejerhed L, Zaffagnini S, Röpke M, Nizard R (2009) Patellar tendon versus hamstring tendon autografts for reconstructing the anterior cruciate ligament: a meta-analysis based on individual patient data. Am J Sports Med 37(12):2470–2478

    Article  PubMed  Google Scholar 

  27. Hantes ME, Zachos VC, Bargiotas KA, Basdekis GK, Karantanas AH, Malizos KN (2007) Patellar tendon length after anterior cruciate ligament reconstruction: a comparative magnetic resonance imaging study between patellar and hamstring tendon autografts. Knee Surg Sports Traumatol Arthrosc 15(6):712–719

    Article  PubMed  Google Scholar 

  28. Hospodar SJ, Miller MD (2009) Controversies in ACL reconstruction: bone-patellar tendon-bone anterior cruciate ligament reconstruction remains the gold standard. Sports Med Arthrosc. 17(4):242–246

    Article  PubMed  Google Scholar 

  29. Corry IS, Webb JM, Clingeleffer AJ, Pinczewski LA (1999) Arthroscopic reconstruction of the anterior cruciate ligament. A comparison of patellar tendon autograft and four-strand hamstring tendon autograft. Am J Sports Med 27(4):444–454

    CAS  PubMed  Google Scholar 

  30. DeAngelis JP, Fulkerson JP (2007) Quadriceps tendon–a reliable alternative for reconstruction of the anterior cruciate ligament. Clin Sports Med 26(4):587–596

    Article  PubMed  Google Scholar 

  31. Mastrokalos DS, Springer J, Siebold R, Paessler HH (2005) Donor site morbidity and return to the preinjury activity level after anterior cruciate ligament reconstruction using ipsilateral and contralateral patellar tendon autograft: a retrospective, nonrandomized study. Am J Sports Med 33(1):85–93

    Article  PubMed  Google Scholar 

  32. Passler HH (2010) Anatomic anterior cruciate ligament reconstruction with hamstrings using press-fit fixation without hardward: operative technique and long-term results of a prospective and randomized study. Unfallchirurg 113(7):555–560

    Article  CAS  PubMed  Google Scholar 

  33. Yasuda K, Tsujino J, Ohkoshi Y, Tanabe Y, Kaneda K (1995) Graft site morbidity with autogenous semitendinosus and gracilis tendons. Am J Sports Med 23:706–714

    Article  CAS  PubMed  Google Scholar 

  34. Chang SK, Egami DK, Shaieb MD, Kan DM, Richardson AB (2003) Anterior cruciate ligament reconstruction: allograft versus autograft. Arthroscopy 19(5):453–462

    Article  PubMed  Google Scholar 

  35. Kartus J, Stener S, Lindahl S, Engstr¨om B B, Eriksson BI, Karlsson J (1997) Factors affecting donor-site morbidity after anterior cruciate ligament reconstruction using bone-patellar tendon-bone autografts. Knee Surg Sports Traumatol Arthrosc 5(4):222–228

    Article  CAS  PubMed  Google Scholar 

  36. Kartus J, Ejerhed L, Sernert N, Brandsson S, Karlsson J (2000) Comparison of traditional and subcutaneous patellar tendon harvest. A prospective study of donor site-related problems after anterior cruciate ligament reconstruction using different graft harvesting techniques. Am J Sports Med 28(3):328–335

    CAS  PubMed  Google Scholar 

  37. Tifford CD, Spero L, Luke T, Plancher KD (2000) The relationship of the infrapatellar branches of the saphenous nerve to arthroscopy portals and incisions for anterior cruciate ligament surgery. An anatomic study. Am J Sports Med 28(4):562–567

    CAS  PubMed  Google Scholar 

  38. Boszotta H, Prunner K (2000) Refilling of removal defects: Impact on extensor mechanism complaints after use of a bone tendon-bone graft for anterior cruciate ligament reconstruction. Arthroscopy 16:160–164

    Article  CAS  PubMed  Google Scholar 

  39. Mast R, Neubert M, Steinbrück K (1991) Ultrasound and clinical findings of the patellar ligament after excision of the central third for cruciate ligament-plasty. Sportverletz Sportschadenc 5(4):199–201

    Article  CAS  Google Scholar 

  40. Wiley JP, Bray RC, Wiseman DA, Elliott PD, Ladly KO, Vale LA (1997) Serial ultrasonographic imaging evaluation of the patellar tendon after harvesting its central one third for anterior cruciate ligament reconstruction. J Ultrasound Med 16(4):251–255

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Orthopaedic Surgery, Artroscopia G.C., Fundación García-Cugat, Hospital Quirón Barcelona, Universitat Internacional de Catalunya Pza, Alfonso Comín 5-7, 08023, Barcelona, Spain

    Roberto Seijas, Xavier Cuscó, Oscar Ares & Ramón Cugat

  2. Hospital Vall d’Hebrón, Barcelona, Spain

    Andrea Sallent

  3. Veterinarian Surgery University of Valencia, Valencia, Spain

    Iván Serra

  4. Hospital Clínic Barcelona, Barcelona, Spain

    Oscar Ares

Authors
  1. Roberto Seijas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xavier Cuscó
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andrea Sallent
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Iván Serra
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Oscar Ares
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ramón Cugat
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Roberto Seijas.

Ethics declarations

Conflict of interests

Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article

Ethical review

The present study was reviewed and approved by the Ethical Committee at Hospital Quirón, Barcelona

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Seijas, R., Cuscó, X., Sallent, A. et al. Pain in donor site after BTB-ACL reconstruction with PRGF: a randomized trial. Arch Orthop Trauma Surg 136, 829–835 (2016). https://doi.org/10.1007/s00402-016-2458-0

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-016-2458-0

Keywords

Search

Navigation