Bert Mandelbaum, MD, described the evidence supporting orthobiologic treatments for torn anterior cruciate ligaments in a Medscape column.
Dr. Mandelbaum is a board-certified orthopedic sports medicine surgeon at Los Angeles-based Cedars-Sinai Kerlan-Jobe Institute. He highlighted the three potential benefits of using platelet-rich plasma to treat torn ACLs. They are:
- Potentially increased gene expression for growth factors
- Potentially enhanced cell proliferation and angiogenesis
- Possibly summoning the appropriate mesenchymal stem cells to the site of regeneration
"PRP may facilitate the early stages of graft remodeling, revascularization, and reinnervation and maturation," Dr. Mandelbaum wrote in the Medscape column.
He claims whole blood may be as effective as PRP in treating torn ACLs, citing a study in the Orthopaedic Journal of Sports Medicine in which researchers augmented a suture repair with the bridge-enhanced ACL repair scaffold placed between the torn ends of the ACL.
The researchers added 10 millimeters of autologous whole blood to the scaffold before wound closure; compared with patients grafted with hamstring, the patients who received the repair and scaffold had significantly stronger hamstrings three-months postoperatively.
Dr. Mandelbaum frequently uses PRP in his own practice and is studying its effects in treating torn ACLs. He found that at three months after the procedure over 90 percent of the grafts are mature — without PRP, the process takes up to 12 months.