Biological Approach to Anterior Cruciate Ligament Surgery

We present a novel technique for reconstruction of the anterior cruciate ligament with autologous ipsilateral hamstring tendons, assisted by platelet-rich plasma (PRP). PRP serves as a source of growth factors and cytokines to speed up the process of ligamentization and tendon-bone consolidation. Before implantation, the hamstring tendons are treated with liquid-activated PRP, so that a fibrin scaffold is formed within the tendons. The intratendinous location of the PRP scaffold was confirmed in Achilles tendons of sheep after injecting liquid-activated PRP stained with Indian blue ink. In the technique described, the tibial tunnel is produced using 2 trephines of different diameters, which allows to harvest 2 bone blocks with different diameters. The bone blocks are also treated with PRP before reimplantation. The tibial tunnel, which is wider distally, allows unconstrained positioning and drilling of the femoral socket within the isometric area. The graft is secured in the femur using transcondylar fixation. For tibial fixation, the PRP-treated bone blocks are introduced within the tunnel, firmly compacted, and left in the precise position that facilitated reconstruction of the tibial anatomy. Liquid-activated PRP is injected in both bone tunnels. To reduce morbidity associated with autografts, a platelet and fibrin scaffold is introduced in the donor region, and the preserved fascia of the pes anserinus is carefully sutured.