Clinical Outcomes of Platelet-Rich Plasma Augmentation in Anterior Cruciate Ligament Reconstruction Using Hamstring Tendon Autografts: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Abstract

Anterior cruciate ligament reconstruction (ACLR) with hamstring tendon (HT) autograft is a common procedure for which interest is increasing regarding the use of platelet-rich plasma (PRP) to enhance surgical outcomes. To systematically review the effect of PRP augmentation on the clinical outcomes of ACLR using HT autografts through a meta-analysis of randomized controlled trials (RCTs). Meta-analysis; Level of evidence, 2. The PubMed, Embase, Cochrane Library, and Google Scholar databases were comprehensively searched for articles published up until November 1, 2024. The inclusion criteria were RCTs that reported clinical outcomes of patients undergoing ACLR with HT autografts involving PRP augmentation. The methodological quality of the selected studies was assessed using the Cochrane Collaboration's risk-of-bias tool. Among 1722 studies initially identified across databases, 11 studies with 583 patients were included in the analysis. The results of the meta-analysis indicated that PRP significantly improved residual anterior-posterior laxity at 3 months (mean difference [MD], -1.12; 95% CI, -1.64 to -0.60; <i>P</i> < .001) and 6 months (MD, -2.00; 95% CI, -3.17 to -0.83; <i>P</i> < .001) but not at 12 months (MD, 0.03; 95% CI, -0.31 to 0.38; <i>P</i> = .847). The Lysholm score did not differ significantly between the PRP and control groups at 3 months (MD, 0.34; 95% CI, -1.20 to 1.87; <i>P</i> = .666), 6 months (MD, -3.35; 95% CI, -10.68 to 3.98; <i>P</i> = .370), or 12 months (MD, 0.73; 95% CI, -1.41 to 2.88; <i>P</i> = .502). No significant heterogeneity was observed in any meta-analysis. PRP augmentation in ACLR using HT autografts showed potential short-term benefits including reduced residual anterior-posterior laxity and improved radiological findings. However, these effects were not sustained in the long term, and no significant differences in patient-reported outcomes were observed over time.