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.

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.