Original Article| Volume 26, ISSUE 1, P50-57, January 2010

Download started.


Comparison of Magnetic Resonance Imaging Findings in Anterior Cruciate Ligament Grafts With and Without Autologous Platelet-Derived Growth Factors


      To determine whether the use of platelet-rich plasma gel (PRPG) affects magnetic resonance imaging (MRI) findings in the anterior cruciate ligament (ACL) graft during the first year after reconstruction.


      A prospective single-blinded study of 50 ACL reconstructions in 50 patients was performed. In group A (study group) PRPG was added to the graft with a standardized technique, and in group B (control group) no PRPG was added. An MRI study was performed postoperatively between 3 and 9 months in group A and between 3 and 12 months in group B. The imaging analysis was performed in a blind protocol by the same radiologist.


      The mean heterogeneity score value at the time of MRI, assigned by the radiologist, was 1.14 in group A and 3.25 in group B. Both groups were comparable in terms of sex and age (P < .05). The mean time to obtain a completely homogeneous intra-articular segment in group A (PRPG added) was 177 days after surgery, and it was 369 days in group B. Using the quadratic predictive model, these findings show that group A (PRPG added) needed only 48% of the time group B required to achieve the same MRI image (P < .001).


      ACL reconstruction with the use of PRPG achieves complete homogeneous grafts assessed by MRI, in 179 days compared with 369 days for ACL reconstruction without PRPG. This represents a time shortening of 48% with respect to ACL reconstruction without PRPG.

      Level of Evidence

      Level III, case-control study.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Arnoczky S.P.
        • Tarvin G.B.
        Anterior cruciate ligament replacement using patellar tendon: An evaluation of graft revascularization in the dog.
        J Bone Joint Surg Am. 1982; 64: 217-224
        • Falconiero R.P.
        • DiStefano V.J.
        • Cook T.M.
        Revascularization and ligamentization of autogenous anterior cruciate ligament grafts in humans.
        Arthroscopy. 1998; 14: 197-205
        • Kleiner J.B.
        • Amiel D.
        • Harwood F.L.
        • Akeson W.H.
        Early histologic, metabolic, and vascular assessment of anterior cruciate ligament autografts.
        J Orthop Res. 1989; 7: 235-242
        • Abe S.
        • Kurosaka M.
        • Iguchi T.
        • Yoshiya S.
        • Hirohata K.
        Light and electron microscopic study of remodeling and maturation process in autogenous graft for anterior cruciate ligament reconstruction.
        Arthroscopy. 1993; 9: 394-405
        • Grøntvedt T.
        • Engebretsen L.
        • Rossvoll I.
        • Smevik O.
        • Nilsen G.
        Comparison between magnetic resonance imaging findings and knee stability: Measurements after anterior cruciate ligament repair with and without augmentation.
        Am J Sports Med. 1996; 23: 729-735
        • Howell S.M.
        • Clark J.A.
        • Blasier R.D.
        Serial magnetic resonance imaging of hamstring anterior cruciate ligament autografts during the first year of implantation.
        Am J Sports Med. 1991; 19: 42-47
        • Maywood R.M.
        • Murphy B.J.
        • Uribe J.W.
        • et al.
        Evaluation of arthroscopic anterior cruciate ligament reconstruction using magnetic resonance imaging.
        Am J Sports Med. 1993; 21: 523-527
        • Rougraff B.T.
        • Shelbourne K.D.
        Early histologic appearance of human patellar tendon autografts used for anterior cruciate ligament reconstruction.
        Knee Surg Sports Traumatol Arthrosc. 1999; 7: 9-14
        • Unterhauser F.N.
        • Bail H.J.
        • Höher J.
        • Haas N.P.
        • Weiler A.
        Endoligamentous revascularization of an anterior cruciate ligament graft.
        Clin Orthop Relat Res. 2003; : 276-288
        • Yoshikawa T.
        • Tohyama H.
        • Enomoto H.
        • Matsumoto H.
        • Toyama Y.
        • Yasuda K.
        Temporal changes in relationships between fibroblast repopulation, VEGF expression, and angiogenesis in the patellar tendon graft after ACL reconstruction.
        Trans Orthop Res Soc. 2003; 29: 236
        • Radice F.
        • Gutierrez V.
        • Ibarra A.
        Arthroscopic, histologic and MRI correlation in the maturation process of the graft in ACL reconstruction in humans.
        Arthroscopy. 1998; 14 (Abstracts presented at the First Biennial Congress of ISAKOS): S20
        • Weiler A.
        • Peters G.
        • Mäurer J.
        • Unterhauser F.N.
        • Südkamp N.P.
        Biomechanical properties and vascularity of an anterior cruciate ligament graft can be predicted by contrast-enhanced magnetic resonance imaging.
        Am J Sports Med. 2001; 29: 751-761
        • Hildebrand K.A.
        • Woo S.L.-Y.
        • Smith D.W.
        • et al.
        The effects of platelet-derived growth factor-BB on healing of the rabbit medial collateral ligament.
        Am J Sports Med. 1998; 26: 549-554
        • Anderson K.
        • Seneviratne A.M.
        • Izawa K.
        • Atkinson B.L.
        • Potter H.G.
        • Rodeo S.A.
        Augmentation of tendon healing in an intra-articular bone tunnel with use of a bone growth factor.
        Am J Sports Med. 2001; 29: 689-698
        • Jenner J.M.
        • van Eijk F.
        • Saris D.B.
        • Willems W.J.
        • Dhert W.J.
        • Creemers L.B.
        Effect of transforming growth factor-beta and growth differentiation factor-5 on proliferation and matrix production by human bone marrow stromal cells cultured on braided poly lactic-coglycolic acid scaffolds for ligament tissue engineering.
        Tissue Eng. 2007; 13: 1573-1582
        • Kondo E.
        • Yasuda K.
        • Yamanaka M.
        • Minami A.
        • Tohyama H.
        Effects of administration of exogenous growth factors on biomechanical properties of the elongation-type anterior cruciate ligament injury with partial laceration.
        Am J Sports Med. 2005; 33: 188-196
        • Lee J.
        • Green M.H.
        • Amiel D.
        Synergistic effect of growth factors on cell outgrowth from explants of rabbit anterior cruciate and medial collateral ligaments.
        J Orthop Res. 1995; 13: 435-441
        • Letson A.K.
        • Dahners L.E.
        The effect of combinations of growth factors on ligament healing.
        Clin Orthop Relat Res. 1994; : 207-212
        • Marui T.
        • Niyibizi C.
        • Georgescu H.I.
        • et al.
        Effects of growth factors on matrix synthesis by ligament fibroblasts.
        J Orthop Res. 1997; 15: 18-23
        • Murray M.M.
        • Spindler K.P.
        • Abreu E.
        • et al.
        Collagen-platelet rich plasma hydrogel enhances primary repair of the porcine anterior cruciate ligament.
        J Orthop Res. 2007; 25: 81-91
        • Pierce G.F.
        • Mustoe T.A.
        • Lingelbach J.
        • et al.
        Platelet-derived growth factor and transforming growth factor–β enhance tissue repair activities by unique mechanisms.
        J Cell Biol. 2000; 109: 429-440
        • Sanchez M.
        • Anitua E.
        • Azofra J.
        • Andía I.
        • Padilla S.
        • Mujika I.
        Comparison of surgically repaired achilles tendon tears using platelet-rich fibrin matrices.
        Am J Sports Med. 2007; 35: 245-251
        • Sánchez M.
        • Azofra J.
        • Aizpurua B.
        • Elorriaga R.
        • Anitua E.
        • Andia I.
        Application in arthroscopic surgery of autologous plasma rich in growth factors.
        Cuad Artrosc. 2003; 10 (in Spanish): 12-19
        • Anitua E.
        • Andia I.
        • Sanchez M.
        • et al.
        Autologous preparations rich in growth factors promote proliferation and induce VEGF and HGF production by human tendon cells in culture.
        J Orthop Res. 2005; 23: 281-286
        • Azuma H.
        • Yasuda K.
        • Tohyama H.
        • et al.
        Timing of administration of transforming growth factor–beta and epidermal growth factor influences the effect on material properties of the in situ frozen-thawed anterior cruciate ligament.
        J Biomech. 2003; 36: 373-381
        • Sakai T.
        • Yasuda K.
        • Tohyama H.
        • et al.
        Effects of combined administration of transforming growth factor-beta 1 and epidermal growth factor on properties of the in situ frozen ACL in rabbits.
        J Orthop Res. 2002; 20: 1345-1351
        • Weiler A.
        • Förster C.
        • Hunt P.
        • et al.
        The influence of locally applied platelet-derived growth factor–BB on free tendon graft remodeling after anterior cruciate ligament reconstruction.
        Am J Sports Med. 2004; 32: 881-891
        • Yasuda K.
        • Tomita F.
        • Yamazaki S.
        • Minami A.
        • Tohyama H.
        The effect of growth factors on biomechanical properties of the bone–patellar tendon–bone graft after anterior cruciate ligament reconstruction: A canine model study.
        Am J Sports Med. 2004; 32: 870-880
        • Yamazaki S.
        • Yasuda K.
        • Tomita F.
        • Tohyama H.
        • Minami A.
        The effect of transforming growth factor-1 on intraosseous healing of flexor tendon autograft replacement of ACL in dogs.
        Arthroscopy. 2005; 21: 1034-1041
        • Steiner M.E.
        • Murray M.M.
        • Rodeo S.A.
        Strategies to improve anterior cruciate ligament healing and graft placement.
        Am J Sports Med. 2008; 36: 176-189
        • Orrego M.
        • Larrain C.
        • Rosales J.
        • et al.
        Effects of platelet concentrate and bone plug on the healing of hamstring tendons in bone tunnel.
        Arthroscopy. 2008; 24: 1373-1380
        • de Mos M.
        • van der Windt A.
        • Jahr H.
        • et al.
        Can platelet-rich plasma enhance tendon repair?.
        Am J Sports Med. 2008; 36: 1171-1178
        • Radice F.
        • Yañez R.
        • Gutiérrez V.
        • Pinedo M.
        Application of platelet-derived growth factors in ACL reconstruction.
        NotiSLARD. 2007; 2: 7-8
        • Radice F.
        Preparation of the graft in ACL reconstruction, applying platelet-derived growth factors.
        November 2005
        • Ju Y.J.
        • Tohyama H.
        • Kondo E.
        • et al.
        Effects of local administration of vascular endothelial growth factor on properties of the in situ frozen thawed anterior cruciate ligament in rabbits.
        Am J Sports Med. 2006; 34: 84-91
        • Yoshikawa T.
        • Tohyama H.
        • Katsura T.
        • et al.
        Effects of local administration of vascular endothelial growth factor on mechanical characteristics of the semitendinosus tendon graft after anterior cruciate ligament reconstruction in sheep.
        Am J Sports Med. 2006; 36: 1918-1925