Platelet-Rich Plasma Augmentation in Anterior Cruciate Ligament Reconstruction: Effects on Early Functional Recovery and Graft Maturation

Abstract

Background: Anterior cruciate ligament reconstruction (ACLR) reliably restores mechanical stability, yet graft incorporation and intra-articular ligamentization remain biologically prolonged. Platelet-rich plasma (PRP) provides a concentrated autologous source of growth factors that may accelerate tendon–bone integration and graft remodeling, although clinical evidence remains inconsistent. This study evaluated whether intraoperative PRP augmentation improved early recovery, knee function, stability, and magnetic resonance imaging (MRI) graft maturation after primary ACLR.

Methods: In this prospective random       ized comparative study, 80 adults undergoing primary single-bundle ACLR with hamstring autograft were allocated to PRP augmentation (n=40) or standard ACLR (n=40). Leukocyte-poor PRP was applied to the graft and bone tunnels in the intervention arm. International Knee Documentation Committee (IKDC), Lysholm, visual analogue scale (VAS) pain, Tegner activity, KT-1000 arthrometry, and MRI graft signal-to-noise quotient (SNQ) were assessed through 12 months. Between-group comparisons used independent-samples tests, repeated-measures models, and categorical analyses with two-sided α=0.05.

Results: Baseline characteristics were comparable. IKDC scores favored PRP at 3 months (73.8±8.2 vs 69.9±8.6; p=0.041) and 6 months (84.6±7.2 vs 80.5±8.0; p=0.018), but not at 12 months (91.2±5.8 vs 89.4±6.5; p=0.195). Six-month Lysholm scores were also higher with PRP (87.9±6.8 vs 84.2±7.4; p=0.022). Pain was lower at 1 week and 6 weeks, whereas the difference disappeared by 3 months. MRI SNQ at 6 months was lower with PRP (2.42±0.68 vs 2.96±0.77; p=0.002), consistent with earlier graft maturation, but the 12-month difference was nonsignificant. KT-1000 laxity, tunnel widening, return-to-sport, and complication rates were similar.

Conclusion: PRP augmentation was associated with modest early improvements in pain, patient-reported function, and MRI graft maturation after ACLR, without a sustained 12-month advantage in knee stability or functional outcome. These findings support PRP as a potential biological adjunct for early recovery rather than a substitute for sound reconstruction and rehabilitation. Standardized PRP characterization and adequately powered multicentre trials are required before routine adoption.