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Effect of platelet-rich plasma in Achilles tendon allograft in rabbits

  • Seok-Hong Park (College of Veterinary Medicine, Kyungpook National University) ;
  • Dong-Yub Kim (College of Veterinary Medicine, Kyungpook National University) ;
  • Won-Jae Lee (College of Veterinary Medicine, Kyungpook National University) ;
  • Min Jang (College of Veterinary Medicine, Kyungpook National University) ;
  • Seong Mok Jeong (Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University) ;
  • Sae-Kwang Ku (Department of Anatomy and Histology, College of Korean Medicine, Daegu Haany University) ;
  • Young-Sam Kwon (College of Veterinary Medicine, Kyungpook National University) ;
  • Sungho Yun (College of Veterinary Medicine, Kyungpook National University)
  • Received : 2023.11.13
  • Accepted : 2024.01.22
  • Published : 2024.03.31

Abstract

Background: Achilles tendon is composed of dense connective tissue and is one of the largest tendons in the body. In veterinary medicine, acute ruptures are associated with impact injury or sharp trauma. Healing of the ruptured tendon is challenging because of poor blood and nerve supply as well as the residual cell population. Platelet-rich plasma (PRP) contains numerous bioactive agents and growth factors and has been utilized to promote healing in bone, soft tissue, and tendons. Objective: The purpose of this study was to evaluate the healing effect of PRP injected into the surrounding fascia of the Achilles tendon after allograft in rabbits. Methods: Donor rabbits (n = 8) were anesthetized and 16 lateral gastrocnemius tendons were fully transected bilaterally. Transected tendons were decellularized and stored at -80℃ prior to allograft. The allograft was placed on the partially transected medial gastrocnemius tendon in the left hindlimb of 16 rabbits. The allograft PRP group (n = 8) had 0.3 mL of PRP administered in the tendon and the allograft control group (n = 8) did not receive any treatment. After 8 weeks, rabbits were euthanatized and allograft tendons were transected for macroscopic, biomechanical, and histological assessment. Results: The allograft PRP group exhibited superior macroscopic assessment scores, greater tensile strength, and a histologically enhanced healing process compared to those in the allograft control group. Conclusions: Our results suggest administration of PRP on an allograft tendon has a positive effect on the healing process in a ruptured Achilles tendon.

Keywords

References

  1. Ho TC, Tsai SH, Yeh SI, Chen SL, Tung KY, Chien HY, et al. PEDF-derived peptide promotes tendon regeneration through its mitogenic effect on tendon stem/progenitor cells. Stem Cell Res Ther. 2019;10(1):2.
  2. Doral MN, Alam M, Bozkurt M, Turhan E, Atay OA, Donmez G, et al. Functional anatomy of the Achilles tendon. Knee Surg Sports Traumatol Arthrosc. 2010;18(5):638-643.
  3. Mazzone MF, McCue T. Common conditions of the Achilles tendon. Am Fam Physician. 2002;65(9):1805-1810.
  4. Skalec A, Janeczek M, Czerski A. Anatomy and histology of the rabbit common calcanean tendon. Anat Histol Embryol. 2019;48(5):466-475.
  5. Moller A, Astron M, Westlin N. Increasing incidence of Achilles tendon rupture. Acta Orthop Scand. 1996;67(5):479-481. 
  6. Harasen G. Ruptures of the common calcaneal tendon. Can Vet J. 2006;47(12):1219-1220.
  7. King M, Jerram R. Achilles tendon rupture in dogs. Compend Contin Educ Pract Vet. 2003;25:613-622. 
  8. Hess GW. Achilles tendon rupture: a review of etiology, population, anatomy, risk factors, and injury prevention. Foot Ankle Spec. 2010;3(1):29-32.
  9. Aspenberg P. Stimulation of tendon repair: mechanical loading, GDFs and platelets. A mini-review. Int Orthop. 2007;31(6):783-789.
  10. Stoll C, John T, Conrad C, Lohan A, Hondke S, Ertel W, et al. Healing parameters in a rabbit partial tendon defect following tenocyte/biomaterial implantation. Biomaterials. 2011;32(21):4806-4815.
  11. Sharma P, Maffulli N. Basic biology of tendon injury and healing. Surgeon. 2005;3(5):309-316.
  12. Grove JR. Autograft, allograft and xenograft options in the treatment of neglected Achilles tendon ruptures: a historical review with illustration of surgical repair. Surgeon. 2008;15:47. 
  13. Wapner KL, Hecht PJ, Mills RH Jr. Reconstruction of neglected Achilles tendon injury. Orthop Clin North Am. 1995;26(2):249-263.
  14. Cohen SB, Sekiya JK. Allograft safety in anterior cruciate ligament reconstruction. Clin Sports Med. 2007;26(4):597-605.
  15. Giedraitis A, Arnoczky SP, Bedi A. Allografts in soft tissue reconstructive procedures: important considerations. Sports Health. 2014;6(3):256-264.
  16. De Carli A, Lanzetti RM, Ciompi A, Lupariello D, Vadala A, Argento G, et al. Can platelet-rich plasma have a role in Achilles tendon surgical repair? Knee Surg Sports Traumatol Arthrosc. 2016;24(7):2231-2237.
  17. Anitua E, Andia I, Sanchez M, Azofra J, del Mar Zalduendo M, de la Fuente M, et al. Autologous preparations rich in growth factors promote proliferation and induce VEGF and HGF production by human tendon cells in culture. J Orthop Res. 2005;23(2):281-286.
  18. Andia I, Sanchez M, Maffulli N. Tendon healing and platelet-rich plasma therapies. Expert Opin Biol Ther. 2010;10(10):1415-1426.
  19. Bottagisio M, D'Arrigo D, Talo G, Bongio M, Ferroni M, Boschetti F, et al. Achilles tendon repair by decellularized and engineered xenografts in a rabbit model. Stem Cells Int. 2019;2019:5267479.
  20. Whitlock PW, Smith TL, Poehling GG, Shilt JS, Van Dyke M. A naturally derived, cytocompatible, and architecturally optimized scaffold for tendon and ligament regeneration. Biomaterials. 2007;28(29):4321-4329.
  21. Jo CH, Roh YH, Kim JE, Shin S, Yoon KS. Optimizing platelet-rich plasma gel formation by varying time and gravitational forces during centrifugation. J Oral Implantol. 2013;39(5):525-532.
  22. Lyras DN, Kazakos K, Georgiadis G, Mazis G, Middleton R, Richards S, et al. Does a single application of PRP alter the expression of IGF-I in the early phase of tendon healing? J Foot Ankle Surg. 2011;50(3):276-282.
  23. Lim JM, Lee YJ, Cho HR, Park DC, Jung GW, Ku SK, et al. Extracellular polysaccharides purified from Aureobasidium pullulans SM-2001 (Polycan) inhibit dexamethasone-induced muscle atrophy in mice. Int J Mol Med. 2018;41(3):1245-1264.
  24. Zheng Y, Zhou Y, Zhang X, Chen Y, Zheng X, Cheng T, et al. Effects of hypoxia on differentiation of menstrual blood stromal stem cells towards tenogenic cells in a co-culture system with Achilles tendon cells. Exp Ther Med. 2017;13(6):3195-3202.
  25. Tsai YP, Chang CW, Lee JS, Liang JI, Hsieh TH, Yeh ML, et al. Direct radiofrequency application improves pain and gait in collagenase-induced acute Achilles tendon injury. Evid Based Complement Alternat Med. 2013;2013:402692.
  26. Takamura M, Yasuda T, Nakano A, Shima H, Neo M. The effect of platelet-rich plasma on Achilles tendon healing in a rabbit model. Acta Orthop Traumatol Turc. 2017;51(1):65-72.
  27. Wang T, Lin Z, Day RE, Gardiner B, Landao-Bassonga E, Rubenson J, et al. Programmable mechanical stimulation influences tendon homeostasis in a bioreactor system. Biotechnol Bioeng. 2013;110(5):1495-1507.
  28. Kim YI, Oh WS, Song PH, Yun S, Kwon YS, Lee YJ, et al. Anti-photoaging effects of low molecular-weight fucoidan on ultraviolet B-irradiated mice. Mar Drugs. 2018;16(8):286.
  29. Movin T, Gad A, Reinholt FP, Rolf C. Tendon pathology in long-standing achillodynia. Biopsy findings in 40 patients. Acta Orthop Scand. 1997;68(2):170-175. 
  30. Thorpe CT, Birch HL, Clegg PD, Screen HR. The role of the non-collagenous matrix in tendon function. Int J Exp Pathol. 2013;94(4):248-259.
  31. Khan RJ, Fick D, Keogh A, Crawford J, Brammar T, Parker M. Treatment of acute achilles tendon ruptures. A meta-analysis of randomized, controlled trials. J Bone Joint Surg Am. 2005;87(10):2202-2210.
  32. Pavlovic V, Ciric M, Jovanovic V, Stojanovic P. Platelet Rich Plasma: a short overview of certain bioactive components. Open Med (Wars). 2016;11(1):242-247.
  33. Mishra A, Woodall J Jr, Vieira A. Treatment of tendon and muscle using platelet-rich plasma. Clin Sports Med. 2009;28(1):113-125.
  34. Scherer SS, Tobalem M, Vigato E, Heit Y, Modarressi A, Hinz B, et al. Nonactivated versus thrombin-activated platelets on wound healing and fibroblast-to-myofibroblast differentiation in vivo and in vitro. Plast Reconstr Surg. 2012;129(1):46e-54e.
  35. Murphy PG, Loitz BJ, Frank CB, Hart DA. Influence of exogenous growth factors on the synthesis and secretion of collagen types I and III by explants of normal and healing rabbit ligaments. Biochem Cell Biol. 1994;72(9-10):403-409.
  36. Oakes BW. Tissue healing and repair: tendons and ligaments. In: Frontera WR, editor. Rehabilitation of Sports Injuries: Scientific Basis. Hoboken: Wiley; 2003, 28-98. 
  37. Tillan L. Properties of dense connective tissue and wound healing. In: Hertling D, Kessler RM, editors. Management of Common Musculoskeletal Disorders. Philadelphia: Lippincott Williams & Wilkins; 1996, 8-21. 
  38. Rosenbaum AJ, Wicker JF, Dines JS, Bonasser L, Razzano P, Dines DM, et al. Histologic stages of healing correlate with restoration of tensile strength in a model of experimental tendon repair. HSS J. 2010;6(2):164-170.
  39. Enwemeka CS. Inflammation, cellularity, and fibrillogenesis in regenerating tendon: implications for tendon rehabilitation. Phys Ther. 1989;69(10):816-825.
  40. Maffulli N, Ewen SW, Waterston SW, Reaper J, Barrass V. Tenocytes from ruptured and tendinopathic Achilles tendons produce greater quantities of type III collagen than tenocytes from normal Achilles tendons. An in vitro model of human tendon healing. Am J Sports Med. 2000;28(4):499-505.