Patellar Tendon Regeneration With Platelet-rich Plasma - Full Text View

Purpose

The central third of the patellar tendon is used as a donor site for anterior cruciate ligament (ACL) reconstruction. After months or years the harvest site partially regenerates. The regeneration process is accomplished by biological mechanisms,including cells and proteins known as growth factors. The platelets are natural reservoirs of growth factors, and a platelet concentrate known as Platelet-Rich Plasma (PRP) has a three to five fold increase in growth factors. The hypothesis of the study is that the PRP can improve the regeneration of the patellar tendon.

The platelets are obtained from the patient's blood through a filtration system called apheresis, with the use of 250 milliliters of blood, with a sterile system. All the others components of blood (red cells, plasma, white cells) returns to the patient. The PRP is then applied in the harvest site on the patellar tendon, at the end of ACL reconstruction.

The patients are randomized in two groups, one with the use of PRP and the other group without PRP. This information for the patients will be granted just at the end of the research. After the surgery the rehabilitation protocol is the same for both groups. An isokinetic testing is done before the surgery and after six months. Questionnaires about the knee function are asked before the surgery and after six months. A magnetic resonance imaging is performed after six months to evaluate the tendon regeneration.

Condition	Intervention	Phase
Knee Instability	Procedure: Platelet-rich plasma Procedure: Control group	Phase 4

Study Type:	Interventional
Study Design:	Allocation: Randomized Endpoint Classification: Efficacy Study Intervention Model: Parallel Assignment Masking: Double Blind (Subject, Outcomes Assessor) Primary Purpose: Treatment
Official Title:	Regeneration of the Patellar Tendon After Harvesting Its Central Third With Platelet-rich Plasma. Prospective and Randomized Study.

Resource links provided by NLM:

MedlinePlus related topics: MRI Scans Plastic and Cosmetic Surgery

U.S. FDA Resources

Further study details as provided by University of Sao Paulo General Hospital:

Primary Outcome Measures:

Evaluation of the patellar tendon regeneration with magnetic resonance imaging. [ Time Frame: Six months ] [ Designated as safety issue: No ]
Six months after the surgery a magnetic resonance imaging will be done to evaluate the regeneration of the patellar tendon donor site. The area of the gap, related to the tendon harvest, will be measured and compared between the groups.

Secondary Outcome Measures:

Isokinetic testing and questionaires. [ Time Frame: Six months ] [ Designated as safety issue: No ]
Six months after the surgery, patients will answer to questionaires about their knee function and do an isokinetic testing to evaluate their muscle strength. The results will be compared between the groups.

Enrollment:	27
Study Start Date:	November 2008
Study Completion Date:	December 2010
Primary Completion Date:	July 2010 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Experimental: PRP In this group PRP will be used in the patellar tendon donor site.	Procedure: Platelet-rich plasma Intra-operative use of platelet-rich plasma in the patellar tendon after harvesting its central third for ACL reconstruction. Other Names: PRP platelet-rich plasma platelet gel platelet concentrate growth factors concentrate plasma rich in growth factors
Sham Comparator: Control In this group PRP will not be aded to the patellar tendon donor site	Procedure: Control group In this group PRP will not be added to the patellar tendon donor site at the end of ACL reconstruction. Other Names: PRP platelet-rich plasma platelet gel platelet concentrate growth factors concentrate plasma rich in growth factors

Eligibility

Ages Eligible for Study:	up to 45 Years
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

indication of anterior cruciate ligament surgery with patellar ligament
skeletal maturity

Exclusion Criteria:

other knee ligament injuries
severe chondral lesions
osteoarthritis
non-compliance to the rehabilitation
previous surgery in the affected knee
reoperation during the time of the study for an unrelated condition
infection

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT01111747

Sponsors and Collaborators

University of Sao Paulo General Hospital

Instituto de Ortopedia e Traumatologia - HCFMUSP - São Paulo, Brazil

Investigators

Principal Investigator:	Adriano M Almeida, MD	Instituto de Ortopedia e Traumatologia - HCFMUSP - São Paulo, Brazil
Study Director:	Arnaldo J Hernandez, MD, PhD	Instituto de Ortopedia e Traumatologia - HCFMUSP - São Paulo, Brazil

More Information

Publications:

Kartus J, Movin T, Papadogiannakis N, Christensen LR, Lindahl S, Karlsson J. A radiographic and histologic evaluation of the patellar tendon after harvesting its central third. Am J Sports Med. 2000 Mar-Apr;28(2):218-26.

Meisterling RC, Wadsworth T, Ardill R, Griffiths H, Lane-Larsen CL. Morphologic changes in the human patellar tendon after bone-tendon-bone anterior cruciate ligament reconstruction. Clin Orthop Relat Res. 1993 Apr;(289):208-12.

Svensson M, Kartus J, Ejerhed L, Lindahl S, Karlsson J. Does the patellar tendon normalize after harvesting its central third?: a prospective long-term MRI study. Am J Sports Med. 2004 Jan-Feb;32(1):34-8.

Anaguchi Y, Yasuda K, Majima T, Tohyama H, Minami A, Hayashi K. The effect of transforming growth factor-beta on mechanical properties of the fibrous tissue regenerated in the patellar tendon after resecting the central portion. Clin Biomech (Bristol, Avon). 2005 Nov;20(9):959-65.

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 Jan;91(1):4-15. Review.

Spindler KP, Nanney LB, Davidson JM. Proliferative responses to platelet-derived growth factor in young and old rat patellar tendon. Connect Tissue Res. 1995;31(2):171-7.

Molloy T, Wang Y, Murrell G. The roles of growth factors in tendon and ligament healing. Sports Med. 2003;33(5):381-94. Review.

Aspenberg P. Stimulation of tendon repair: mechanical loading, GDFs and platelets. A mini-review. Int Orthop. 2007 Dec;31(6):783-9. Epub 2007 Jun 22.

Rodeo SA, Potter HG, Kawamura S, Turner AS, Kim HJ, Atkinson BL. Biologic augmentation of rotator cuff tendon-healing with use of a mixture of osteoinductive growth factors. J Bone Joint Surg Am. 2007 Nov;89(11):2485-97.

Sánchez 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 Feb;35(2):245-51. Epub 2006 Nov 12.

Responsible Party:	University of Sao Paulo General Hospital
ClinicalTrials.gov Identifier:	NCT01111747 History of Changes
Other Study ID Numbers:	0162/08, CaPPesqHCFMUSP 0162/2008
Study First Received:	April 26, 2010
Last Updated:	March 13, 2012
Health Authority:	Brazil: National Health Surveillance Agency

Keywords provided by University of Sao Paulo General Hospital:

platelet-rich plasma
patellar ligament
regeneration
growth substances

Additional relevant MeSH terms:

Mitogens
Mitosis Modulators
Molecular Mechanisms of Pharmacological Action
Pharmacologic Actions

ClinicalTrials.gov processed this record on May 16, 2013