KSSTA - 2026-06-19 - Journal Article
Biologically enhanced anterior cruciate ligament reconstruction: Platelet-rich plasma or bone marrow aspirate concentrate does not lead to better clinical or radiological outcomes-A randomized controlled trial of 175 cases with 2 years of follow-up.
Mokhtar AA, Gawish H, Abdelgawad A, Deghady A, Hassaan E, Matarawy K, Amer A, Soliman E, Hirschmann MT
Topics
Key Takeaway
PRP and BMAC augmentation of hamstring autograft ACLR produced no improvement in Lysholm, IKDC, or Marx scores at 2 years, and BMAC was associated with worse MRI signal intensity of the graft.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This RCT compared standard semitendinosus quadruple autograft ACLR against PRP- or BMAC-augmented ACLR across 175 patients with standardized technique and biologic preparation. At 2-year follow-up, no significant differences were found in Lysholm (p=0.881), IKDC (p=0.864), Marx activity scale (p=0.666), or MRI graft signal intensity (p=0.898). BMAC-augmented grafts demonstrated worse MRI signal intensity compared to controls, suggesting a potentially detrimental biological effect.
Key Limitation
Two-year follow-up is insufficient to assess whether biologic augmentation affects long-term graft remodeling, tunnel incorporation, or rerupture rates, given that graft maturation continues beyond 24 months.
Original Abstract
PURPOSE
To compare the clinical and radiological outcomes of anterior cruciate ligament reconstruction (ACLR) augmented with platelet-rich plasma (PRP) (1) or bone marrow aspirate concentrate (BMAC) (2) against a control group undergoing standard ACLR without biological additives.
METHODS
One hundred seventy-five patients undergoing biologically enhanced ACLR using semitendinosus quadruple autograft were prospectively included in this randomized controlled trial. Patients were randomized to either the control group (no biological additives, n = 79) or ACLR plus application of PRP to the graft (n = 53) or ACLR plus BMAC application to the graft (n = 43). ACLR techniques were standardized for all patients, and all were performed by a senior surgeon. Biological additives were also standardized and prepared by a senior laboratory physician in the operating room. After an average of 2 years, patients were assessed clinically, and SI of the ACL graft was measured in the magnetic resonance imaging (MRI).
RESULTS
There was no clinically significant difference in clinical outcomes (clinical examination [p = 0.867] and patients' reported outcome scores, Lysholm [p = 0.881], International Knee Documentation Committee [p = 0.864] and Marx activity return to sport scale [p = 0.666]). There was no significant difference in MRI SI of the intra-articular graft or the graft inside the tunnels (p = 0.898) after a mean of 2 years. Cases with BMAC addition to the graft showed poorer MRI SI.
CONCLUSION
Biological ACL reconstruction enhanced with PRP or BMAC did not reveal any statistically significant clinical or radiological results; on the contrary, BMAC application may lead to poorer MRI SI.
LEVEL OF EVIDENCE
Level I, randomized controlled trial.