Effect of platelet-rich plasma for treatment of Achilles tendons in free-moving rats after surgical incision and treatment

Yıl 2015, Cilt: 49 Sayı: 5, 544 - , 24.09.2015

Serdar Yuksel Oktay Adanir Muhammed Gultekin Aysel Caglar Bedri Kucukyildirim Ender Alagoz Mehmet Gulec

Öz

Purpose: The purpose of this study is to investigate, both histopathologically and biomechanically, the effect of platelet rich plasma (PRP) on surgically repaired Achilles tendon rupture recovery in rats

Materials and Methods: The study included 17-month-old 25 male rats of Sprague Dawley type, with a weight average of 500-550 gr. 5 rats were used as donors while 20 rats were separated as a PRP group (n:10) and Control group (n:10). The Achilles tendons of the rats were cut transversely and PRP was administered to the PRP group, while the control group received serum physiologically to create the same surgical effect. In in previous studies, it was shown that this serum does not have any effect on tendon recovery. 15 and 30 days after the treatment, the rats were sacrificed and their Achilles tendons were extracted and examined histopathologically and biomechanically.

Results: Based on the obtained findings, it was observed that the histopathologic Movin and Bonar scores of PRP group in 15th and 30th day were significantly lower than control group (p=0.019, p=0.017) while no significant difference was found in maximum force (F_max) values in biomechanical measures in 15th and 30th day.

Conclusions: It is thought that PRP use in Achilles tendon ruptures positively affects histopathological recovery in early period but that it does not reflect the same effect biomechanically. We believe that PRP use for qualified tendon recovery is beneficial histopathologically.

Keywords: Platelet rich plasma, Achilles tendon injuries, Rat, Histopathology, Biomechanics

 

Anahtar Kelimeler

Achilles tendon injuries; biomechanics; histopathology; platelet-rich plasma; rat

Cerrahi kesi ve tedavi sonrası serbest harekete izin verilen ratlarda aşil tendonu iyileşmesine trombositen zengin plazmanın etkisinin incelenmesi

Öz

Amaç: Bu çalışma ile trombositten zengin plazma (TZP) uygulamasının, ratların cerrahi olarak tamir edilmiş aşil tendon rüptürleri iyileşmesine etkisinin histopatolojik ve biyomekanik açılardan araştırılması amaçlandı.
Gereç ve Yöntem: Çalışmaya 25 adet erkek, 17 aylık, Sprague Dawley cinsi, ağırlıkları ortalama 500-550 gr olan ratlar alındı. 5 rat donör olarak kullanıldı, 20 rat TZP grubu (n:10) ve Kontrol grubu (n:10) olmak üzere 2 gruba ayrıldı. Ratların aşil tendonuna transvers kesi yapılarak TZP grubuna TZP, kontrol grubuna aynı cerrahi etkiyi oluşturmak için, daha önceki çalışmalarda da tarif edildiği gibi tendon iyileşmesine etkisi olmayan serum fizyolojik enjekte edildi. Tedaviden 15 ve 30 gün sonra sakrifiye edilen ratlardan çıkarılan aşil tendonları histopatolojik ve biyomekanik olarak incelendi.
Bulgular: Elde edilen bulgular eşliğinde TZP grubunun 15. ve 30. gün histopatolojik Movin ve Bonar skorları kontrol grubundan istatistiksel olarak anlamlı derecede düşük bulunurken (p=0,019, p=0,017), bu iki grup arasında 15. ve 30. günde yapılan biyomekanik ölçümlerde maksimum kuvvet (Fmax) değerlerinde anlamlı bir fark gözlenmedi(p=0,109, p=0,749).
Çıkarımlar: Aşil tendon rüptürlerinde TZP kullanımının erken dönemde iyileşmeyi histopatolojik yönden olumlu etkilediği ancak aynı etkiyi biyomekanik olarak sağlayamadığı düşünüldü. Histopatolojik olarak kaliteli tendon iyileşmesi için TZP kullanımının faydalı olduğunu düşünmekteyiz.

Anahtar Kelimeler : Trombositten zengin plazma, Aşil tendon yaralanması, Rat, Histopatoloji, Biyomekanik.

 

Anahtar Kelimeler

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Kaynakça

• Karahan M, Erol B. Aşil tendon yırtıklarına yaklaşım. TOTBİD (Türk Ortopedi ve Travmatoloji Birligi Derne- gi) Dergisi 2004;1–2.
• Suchak AA, Bostick G, Reid D, Blitz S, Jomha N. The incidence of Achilles tendon ruptures in Edmonton, Can- ada. Foot Ankle Int 2005;26:932–6.
• Kashiwagi K, Mochizuki Y, Yasunaga Y, Ishida O, Deie M, Ochi M. Effects of transforming growth factor-beta 1 on the early stages of healing of the Achilles tendon in a rat model. Scand J Plast Reconstr Surg Hand Surg 2004;38:193–7.
• Wang XT, Liu PY, Tang JB. Tendon healing in vitro: ge- netic modification of tenocytes with exogenous PDGF gene and promotion of collagen gene expression. J Hand Surg Am 2004;29:884–90.
• Zhang F, Liu H, Stile F, Lei MP, Pang Y, Oswald TM, et al. Effect of vascular endothelial growth factor on rat Achilles tendon healing. Plast Reconstr Surg 2003;112:1613–9.
• Rickert M, Jung M, Adiyaman M, Richter W, Simank HG. A growth and differentiation factor-5 (GDF-5)-coat- ed suture stimulates tendon healing in an Achilles tendon model in rats. Growth Factors 2001;19:115–26.
• Freymiller EG. Platelet-rich plasma: evidence to support its use. J Oral Maxillofac Surg 2004;62:1046–8.
• Rozman P, Bolta Z. Use of platelet growth factors in treat- ing wounds and soft-tissue injuries. Acta Dermatovenerol Alp Pannonica Adriat 2007;16:156–65.
• Roberts AB, Sporn MB. Physiological actions and clinical applications of transforming growth factor-beta (TGF- beta). Growth Factors 1993;8:1–9.
• Marx RE. Platelet-rich plasma (PRP): what is PRP and what is not PRP? Implant Dent 2001;10:225–8.
• Marx RE, Carlson ER, Eichstaedt RM, Schimmele SR, Strauss JE, Georgeff KR. Platelet-rich plasma: Growth factor enhancement for bone grafts. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;85:638–46.
• Babbush CA, Kevy SV, Jacobson MS. An in vitro and in vivo evaluation of autologous platelet concentrate in oral reconstruction. Implant Dent 2003;12:24–34.
• de Vos RJ, Weir A, van Schie HT, Bierma-Zeinstra SM, Verhaar JA, Weinans H, et al. Platelet-rich plasma injec- tion for chronic Achilles tendinopathy: a randomized con- trolled trial. JAMA 2010;303:144–9.
• Krackow KA, Thomas SC, Jones LC. A new stitch for lig- ament-tendon fixation. Brief note. J Bone Joint Surg Am 1986;68:764–6.
• Sánchez M, Anitua E, Azofra J, Andía I, Padilla S, Mu- jika I. Comparison of surgically repaired Achilles tendon tears using platelet-rich fibrin matrices. Am J Sports Med 2007;35:245–51.
• Orrego M, Larrain C, Rosales J, Valenzuela L, Matas J, Durruty J, et al. Effects of platelet concentrate and a bone plug on the healing of hamstring tendons in a bone tunnel. Arthroscopy 2008;24:1373–80.
• Peerbooms JC, Sluimer J, Bruijn DJ, Gosens T. Positive effect of an autologous platelet concentrate in lateral epi- condylitis in a double-blind randomized controlled trial: platelet-rich plasma versus corticosteroid injection with a 1-year follow-up. Am J Sports Med 2010;38:255–62.
• Cetti R, Christensen SE, Ejsted R, Jensen NM, Jorgensen U. Operative versus nonoperative treatment of Achilles tendon rupture. A prospective randomized study and re- view of the literature. Am J Sports Med 1993;21:791–9.
• Puddu G, Ippolito E, Postacchini F. A classification of Achilles tendon disease. Am J Sports Med 1976;4:145–50.
• Aspenberg P, Virchenko O. Platelet concentrate injec- tion improves Achilles tendon repair in rats. Acta Orthop Scand 2004;75:93–9.
• Creaney L, Hamilton B. Growth factor delivery methods in the management of sports injuries: the state of play. Br J Sports Med 2008;42:314,20.
• Spindler KP, Murray MM, Carey JL, Zurakowski D, Fleming BC. The use of platelets to affect functional healing of an anterior cruciate ligament (ACL) autograft in a caprine ACL reconstruction model. J Orthop Res 2009;27:631–8.
• Kaux JF, Drion PV, Colige A, Pascon F, Libertiaux V, Hoffmann A, et al. Effects of platelet-rich plasma (PRP) on the healing of Achilles tendons of rats. Wound Repair Regen 2012;20:748–56.
• Murray MM, Palmer M, Abreu E, Spindler KP, Zura- kowski D, Fleming BC. Platelet-rich plasma alone is not sufficient to enhance suture repair of the ACL in skel- etally immature animals: an in vivo study. J Orthop Res 2009;27:639–45.
• Majewski M, Ochsner PE, Liu F, Flückiger R, Evans CH. Accelerated healing of the rat Achilles tendon in response to autologous conditioned serum. Am J Sports Med 2009;37:2117–25.
• Nurden AT, Nurden P, Sanchez M, Andia I, Anitua E. Platelets and wound healing. Front Biosci 2008;13:3532– 48.
• Gardner MJ, Demetrakopoulos D, Klepchick PR, Mooar PA. The efficacy of autologous platelet gel in pain control and blood loss in total knee arthroplasty. An analysis of the haemoglobin, narcotic requirement and range of mo- tion. Int Orthop 2007;31:309–13.
• Alissa R, Esposito M, Horner K, Oliver R. The influence of platelet-rich plasma on the healing of extraction sock- ets: an explorative randomised clinical trial. Eur J Oral Im- plantol 2010;3:121–34.
• Creaney L, Hamilton B. Growth factor delivery methods in the management of sports injuries: the state of play. Br J Sports Med 2008;42:314–20.
• Amendola N. Surgical treatment of acute rupture of the tendo Achillis led to fewer reruptures and better patient- generated ratings than did nonsurgical treatment. J Bone Joint Surg Am 2002;84–A:324.
• Anitua E, Sánchez M, Nurden AT, Nurden P, Orive G, An- día I. New insights into and novel applications for platelet- rich fibrin therapies. Trends Biotechnol 2006;24:227,34.
• Sadoghi P, Rosso C, Valderrabano V, Leithner A, Vavken P. The role of platelets in the treatment of Achilles tendon injuries. J Orthop Res 2013;31:111–8.
• Hapa O, Çakici H, Yüksel HY, Fırat T, Kükner A, Aygün H. Does platelet-rich plasma enhance microfracture treat- ment for chronic focal chondral defects? An in-vivo study performed in a rat model. Acta Orthop Traumatol Turc 2013;47:201–7.
• Virchenko O, Aspenberg P. How can one platelet injec- tion after tendon injury lead to a stronger tendon after 4 weeks? Interplay between early regeneration and mechani- cal stimulation. Acta Orthop. 2006;77:806–12.
• Morizaki Y, Zhao C, An KN, Amadio PC. The effects of platelet-rich plasma on bone marrow stromal cell transplants for tendon healing in vitro. J Hand Surg Am 2010;35:1833–41.
• Taylor DW, Petrera M, Hendry M, Theodoropoulos JS. A systematic review of the use of platelet-rich plasma in sports medicine as a new treatment for tendon and liga- ment injuries. Clin J Sport Med 2011;21:344–52.