Summary

Our study on Arthroscopic Debridement, Micro fracturing and Leucocyte Poor Platelet Rich Plasma (LP-PRP) injection in rural patients who presented to us with Acl tear and associated with osteochondral defect. Patients were treated post arthroscopy by 2 episodes of LP-PRP, 15 days interval and 1-month post- surgery. they subjected to Rehabilitation and patients were started improving significantly.

Abstract

Background

PRP represents an attractive biological approach to improve the healing of tissues with a low healing potential, such as cartilage. This led to the wide use of PRP, which shows promising results as a minimally invasive injective treatment for knee cartilage degeneration and OA, both in preclinical and clinical studies. Intra-articular biological approaches can represent a suitable option to reduce symptoms and possibly delay surgery in patients with cartilage lesion and OA of the knee.

Objective

To assess pain relief using visual analogue scale system (VAS) and functional outcome by Western Ontario and McMaster universities Arthritis index (WOMAC), The IKDC score used to comprehensively evaluate subjective symptoms and objective signs of the knee joint, with a higher score indicating a better therapeutic effect. Cartilage healing was assessed by MRI in patients who were undergoing LP-PRP therapy, post arthroscopic debridement and micro-fracturing in rural population whom they can’t afford for Mosaicplasty (AOTS).

Materials And Methods

A total number of 15 (n=15) patients who fulfilled the inclusion criteria were included to the study. The study involved male or female patients with ACL injury in the Left or Right knee joint with grade IV Osteochondral defect. All the patients were subjected to standard Arthroscopic ACL Reconstruction using semi-T and gracilis graft which was fixed proximally by adjustable loop endo-button and distally by Bio-screw, Debridement of the osteochondral defect and micro-fracturing of the defect. Standard Rehabilitation protocol followed and non-weight bearing Gradual range of movement exercises followed. one-month post-surgery 2 episodes of Superpose LP-PRP given intra-articularly an interval of 15 days. later rehabilitation continued 6 months post-surgery MRI advice to assess the healing of cartilage and functional assessment was observed by VAS, WOMAC and IKDC score.

Results

The VAS score reflected highly significant improvement in the pain of the knee and functional outcome was assessed by WOMAC index with a significant p value, it was noted that when the pre-procedure VAS score (mean VAS score 9.1) was compared with the score of most recent follow up (mean VAS score 1.6) shows a significant improvement in pain, MRI shows completely healed cartilage post-surgery.

Conclusion

Arthroscopic debridement, Micro-fracturing and Intra-articular autologous LP-PRP injection therapy is a good procedure of choice for treating patients who had osteochondral defect in rural population.