Professor Mayo Clinic Department of PMampR Rochester MN Director Regenerative Medicine Mayo Clinic Sports Medicine Rochester MN Medical Director Mayo Clinic Sports Medicine Minneapolis MN ID: 774740
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Slide1
ACL Orthobiologics
Jonathan T. Finnoff, DO, FACSM
Professor, Mayo Clinic Department of PM&R, Rochester, MN
Director, Regenerative Medicine, Mayo Clinic Sports Medicine, Rochester, MN
Medical Director, Mayo Clinic Sports Medicine, Minneapolis, MN
Program Director, Mayo Clinic Sports Medicine Fellowship, Minneapolis MN
Team Physician, US Ski and Snowboard Team, Timberwolves, Lynx
Slide2Disclosures
COVR Medical – Medical Advisory BoardAim Specialty Health – Medical Advisory BoardSanofi – Medical Advisory BoardUp-to-Date – RoyaltiesDemos Publishing – Royalties
Slide3ACL Orthobiologics
PRP = autologous platelet concentrate made by centrifuging whole bloodPRP has anti-inflammatory properties and contains high levels of growth factors that are involved in healing by recruiting cells, stimulating proliferation, and angiogenesis
Slide4ACL Orthobiologics
Animal studies of PRP with ACL reconstruction1, 4, 9Increased cellular density and neovascularizationImproved bony ingrowthHigher biomechanical strength
Slide5ACL Orthobiologics – PRP Clinical Studies
PRP & collagen membraneDecreased rerupture rate (5% vs 20-35%)2PRP-soaked gelfoam coated BPTB or HS autograft48% reduced time for graft maturation3Earlier return to sport (22 weeks)2
Slide6ACL Orthobiologics – PRP Clinical Studies
Double blind, randomized, controlled trial of BPTB with and without PRP
6
No
reduction
in donor
site morbidity
Meta-analysis of PRP augmented ACL reconstruction
No
difference in short and intermediate follow-up VAS scores over controls
7
Appears safe with no reported complications
7
Slide7ACL Orthobiologics – PRP Clinical Studies
PRP injected into partial thickness ACL sprain may improve outcomes, reduce need for surgery
5, 8
Slide8ACL Orthobiologics – MSC
MSC’s are adult stem cells that can differentiate into mesodermal cell types (e.g., chondrocytes, tenocytes, etc)9Located in multiple tissues (e.g., bone marrow, fat)Potentially represent periocytesMultiple potential MOA, but primary may be signaling
Sampson 2010
Slide9ACL Orthobiologics – MSC Animal Studies
Intra-articular injection of MSC’s into rat knee with partial or complete ACL tear:
10, 11
Increased ligament healing
Improved histological appearance
Increased load to failure
Slide10ACL Orthobiologics – MSC Clinical Studies
10 patients with ACL tears treated with intra-ligamentous injection of BMAC and PRP with fluoroscopic guidance11ACL laxity and MRI tear grade (5 grade 3, 3 grade 2, 2 grade 1) before and after injection7/10 showed improvement (e.g., healed ACL, decreased laxity, improved function, decreased pain)
Slide11ACL Orthobiologics – Study Limitations
Retrospective
No control group
Combined with other interventions (e.g., collagen scaffold, gelatin sponge,
gelfoam
,
etc
)
Short follow-up
PRP characteristics not reported
(
ie
: platelet dose, WBC composition and dose, RBC dose, PRP volume,
etc
)
MSC’s often cultured and expanded
Slide12Conclusion
Data is very preliminary
Majority of data involves use of PRP
PRP appears safe
and may improve surgical outcomes, non-operative outcomes for partial ACL tear, and decrease re-rupture rates
Not enough MSC’s data to draw conclusions, but animal data is interesting
Slide13Thank You
Slide14Bibliography
Hexter
AT, et al. Biological augmentation of graft healing in anterior cruciate ligament reconstruction: a systematic review. Bone Joint J 2018;100-B(3):271-284.
Berdis
AS, et al. Outcomes of anterior cruciate ligament reconstruction using biologic augmentation in 21 years of age and younger. Arthroscopy 2019 (
Epub
ahead of print).
Radice
F, et al. Comparison of magnetic resonance imaging findings in anterior cruciate ligament grafts with and without autologous platelet-derived growth factors. Arthroscopy 2010;26:50-57.
Zhang M, et al. Effect of autologous platelet-rich plasma and gelatin sponge for tendon to bone healing after rabbit anterior cruciate ligament reconstruction. Arthroscopy 2019 (
Epub
ahead of print).
Koch M, et al. Partial anterior cruciate ligament ruptures: advantages by
intraligament
autologous conditioned plasma injection and healing response technique – midterm outcome evaluation. Biomed Res
Int
2018 Jul 25;3204869. e Collection 2018.
Slide15Bibliography
Walters BL, et al. Effect of intraoperative platelet-rich plasma treatment on postoperative donor site knee pain in patellar tendon autograft anterior cruciate ligament reconstruction: a double-blind randomized controlled trial. Am J Sports Med 2018;46(8):1827-1835.
Chen X, et al. The efficacy of platelet-rich plasma on tendon and ligament healing: a systematic review and meta-analysis with bias assessment. Am J Sports Med 2018;46(8):2020-2032.
Seijas
R, et al. Partial anterior cruciate ligament tears treated with
intraligamentary
plasma rich in growth factors. World J
Orthop
2014;5:373-378.
Slide16Bibliography
Dallo
I, et al. Biologic approaches for the treatment of partial tears of the anterior cruciate ligament: a current concepts review.
Orthop
J Sports Med 2017;5(1):2325967116681724.
eCollection
2017 Jan.
Kanaya
A, et al. Intra-articular injection of mesenchymal stromal cells in partially torn anterior cruciate ligaments in a rat model. Arthroscopy 2007;23:610-617.
Centeno CJ, et al. Anterior cruciate ligament tears treated with percutaneous injection of autologous bone marrow nucleated cells: a case series. J Pain Res 2015;8:437-447.