富血小板血浆辅助非手术治疗急性前交叉韧带损伤：临床与MRI结果及成功相关因素分析
简介
该回顾性病例系列纳入40例急性ACL损伤的高活动量患者，伤后6周内接受富血小板血浆注射联合支具固定和分期康复的非手术治疗，随访至少18个月。结果显示95%患者MRI上ACL连续性恢复，82.5%达到全部成功标准（MRI连续性、轴移试验≤1度、重返伤前运动水平、无再手术）；年龄≥30岁、部分撕裂及股骨侧撕裂者成功率更高。作为无对照组的探索性研究，其结果仅具参考…
英文摘要
Anterior cruciate ligament (ACL) reconstruction is commonly recommended for highly active patients, but interest in biologically augmented nonoperative treatment is increasing. This study evaluated clinical and imaging outcomes and explored factors associated with success after platelet-rich plasma (PRP)-assisted nonoperative treatment of acute ACL injuries. This retrospective case series included 40 highly active patients with magnetic resonance imaging (MRI)-confirmed ACL injuries treated within 6 weeks of injury between 2019 and 2023. PRP injections were combined with bracing and staged rehabilitation, and patients were followed for at least 18 months. Treatment success required restored ACL continuity on MRI, a pivot-shift grade ≤1, return to the preinjury sports level, and no major adverse events or subsequent surgery. ACL continuity was restored in 38 patients (95.0%), and 33 (82.5%) met all success criteria. In exploratory analyses, success was more frequent in patients aged ≥30 years than in younger patients (95.2% vs 68.4%, p = 0.027), in partial than complete tears (100.0% vs 66.7%, p = 0.019), and in femoral-side than mid-substance tears (92.6% vs 61.5%, p = 0.029). All seven treatment failures involved complete tears, and five involved mid-substance tears. However, none of these factors was independently associated with treatment failure in exploratory Firth penalized logistic regression. PRP-assisted nonoperative management yielded favorable clinical and MRI outcomes in this selected cohort. These findings are hypothesis-generating, and the independent contribution of PRP cannot be determined because of the retrospective uncontrolled design and limited number of treatment failures.