Summary

The use of ortho-biologics, specifically PRP, does not seem to influence psychological readiness for return to sport at release to return to desired activity.

Abstract

PURPOSE/HYPOTHESIS: Orthopaedic surgeons have given recent attention to use of ortho-biologics to potentially augment the biologic healing timelines after anterior cruciate ligament reconstruction (ACLR) with meniscal repair. Specifically, platelet-rich plasma (PRP) holds potential benefits to enhance the natural healing response but has shown mixed results with regard to measurable clinical benefit. The purpose of this study was to compare psychological readiness and functional outcomes of patients undergoing ACLR with meniscal repair between those who received concomitant intraoperative PRP versus age, gender and graft matched controls. We hypothesized that patients receiving intraoperative PRP would exhibit higher psychological readiness scores at return to sport and better functional outcomes at 2 years when compared to matched controls.

NUMBER OF SUBJECTS: Six hundred seventy-three patients undergoing primary ACLR with meniscal repair from a single surgeon.

Materials And Methods

One hundred sixty-two subjects who received intraoperative PRP were age, sex, and graft-type matched to a control group (n = 162). Baseline data were gathered for patient and surgical demographics including preinjury level of activity (MARX scale), meniscus injury size/location, and mean adjusted gross income (AGI). Psychological readiness was compared at the time of return to sport using the Anterior Cruciate Ligament-Return To Sport After Injury scale (ACL-RSI). At 2 years groups were compared for reinjury rates and subjective knee function (SANE score). Data were assessed for normality using Shapiro-Wilk test and comparisons were analyzed using univariate generalized linear models with an alpha level of .05. RESULTS: There were no baseline differences with regards to BMI (P = .72), MARX score (P = .82), meniscus injury size (P = .83) and location (P = .59). Additionally, no differences were observed for mean AGI between groups (less than $50k/year, P = .95; $50k-$100k/year, P = .37; greater than $100k/year, P = .77). At return to sport, there were no mean differences in ACL-RSI scores between the PRP and control groups, respectively (90.7 versus 87.3, P = .10). At 2 years, there were no differences in the reinjury rate (3.2% versus 3.0%, P = .73) or SANE self-reported knee function score (91.6 ± 11.2 versus 92.4 ± 10.6, P = .60) for those receiving PRP compared to the matched controls.

Conclusions

The added use of intraoperative PRP has no measurable benefit to psychological readiness at return to sport following ACLR with meniscal repair. Additionally, the use of intraoperative PRP does not appear to influence reinjury rates, and self-reported knee function at 2 years.

CLINICAL RELEVANCE: This study suggests that while orthobiologics have promising basic science and theoretic uses, further investigation on the clinical