ULTRASONOGRAPHY GUIDED PLATELET RICH PLASMA (PRP) INFILTRATION IN THE TREATMENT OF MEDIAL COLLATERAL LIGAMENT (MCL) TEAR OF KNEE JOINT

Abstract

Medial collateral ligament (MCL) injuries are one of the most treated knee pathologies in the world of sports medicine. The MCL serves as the primary restraint to valgus force at both 5˚ (57.4%) and 25˚ (78.2%) knee flexion. Conservative care is the standard for Shelbourne Grade 1 and 2 injuries while treatment of Grade 3 injuries remains controversial though good outcomes have been reported with conservative care. The treatment for distal versus proximal MCL injuries does vary based on the extent of the injury, with distal grade 3 often requiring surgery. A general rule of thumb with MCL injury recovery is two weeks off per grade, although it can vary significantly depending on lesion location and treatment progression and the demand of the sport. Platelet-rich plasma (PRP) injections are becoming an increasingly popular adjunct to non-operative treatment protocols. PRP is autologous blood drawn with the intent to concentrate platelet levels higher than physiologic levels, in which, the concentration is typically three to five times higher than the physiologic baseline. Growth factors and other molecules are contained within the alpha granules of platelets that are involved in tissue repair and pain modulation, among other functions.  The use of ultrasound to guide the PRP injection allows the physician performing the injection to evaluate the ligament as well as ensure that the PRP is injected within the site of ligament injury. The study was undertaken to study the effect of Platelet Rich plasma injections in the treatment of medial collateral ligament injury. Material and Methods The aims and objectives were to study the effect of PRP infiltration in MCL tears of knee joints and to compare PRP-infiltrated cases with standard conservative management. This interventional prospective study was carried out in 40 patients with medial collateral ligament tears presenting to Orthopedic OPD in Jawaharlal Nehru Medical College within the study period of 3 years from January 2017 to January 2020. To assess the outcome, the pain was evaluated using the Visual analogue score (VAS) and function was assessed using the international knee documentation committee (IKDC) and Lysholm knee score. Observations and Results  Out of 40 patients, a majority i.e., 24 (60%) were males while 16 (40%) were females. The mean age of patients in our study was 41.86 ± 10.51 SD years. IKDC scores were calculated for both groups at pretreatment, one week, one month and three months and were expressed as mean and standard deviation. Both groups showed significant improvement in IKDC scores individually. When compared to each other, the difference in IKDC scores was statistically significant at all the follow-up intervals i.e., one week, one month and three months (p<0.05). Tegner and Lysholm knee scores were calculated as clinical scores, pain points and swelling points for both groups post-treatment at one week, one month and three months and both groups showed improvement in the scores individually. Conclusion The use of a single injection of Platelet-rich plasma, when injected to grade I and grade II tears of the medial collateral ligament, helps in faster recovery with satisfactory functional outcome.