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Histological Study of the Influence of Plasma Rich in Growth Factors (PRGF) on the Healing of Divided Achilles Tendons in Sheep
J. Andrés Fernández-Sarmiento, DVM1; Juan M. Domínguez, DVM, PhD1; María M. Granados, DVM, PhD1; Juan Morgaz, DVM, PhD1; Rocío Navarrete, DVM, PhD1; José M. Carrillo, DVM, PhD2; Rafael J. Gómez-Villamandos, DVM, PhD1; Pilar Muñoz-Rascón, DVM1; Juana Martín de las Mulas, MD, PhD3; Yolanda Millán, DVM, PhD3; Montserrat García-Balletbó, MD, PhD4; Ramón Cugat, MD, PhD4
1 Department of Animal Medicine and Surgery, University of Córdoba, Campus de Rabanales, Ctra. Madrid – Km 396, 14014, Córdoba, Spain. E-mail address for J.A. Fernández-Sarmiento: v12fesaj@uco.es
2 Department of Animal Medicine and Surgery, Cardenal Herrera University, Edificio Seminario s/n, 46113, Moncada, Valencia, Spain
3 Department of Comparative Pathology, University of Córdoba, Campus de Rabanales, Ctra. Madrid – Km 396, 14014, Córdoba, Spain
4 Department of Orthopaedic Surgery and Traumatology, Hospital Quirón, Plaça d’Alfonso Comin, 5-7, 08023, Barcelona, Spain
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Investigation performed at the Department of Animal Medicine and Surgery, University of Córdoba, Córdoba; the Department of Animal Medicine and Surgery, Cardenal Herrera University, Valencia; the Department of Comparative Pathology, University of Córdoba, Córdoba; and the Deparment of Orthopaedic Surgery and Traumatology, Hospital Quirón, Barcelona, Spain



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Feb 06;95(3):246-255. doi: 10.2106/JBJS.K.01659
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Abstract

Background: 

The use of plasma rich in growth factors (PRGF) has been proposed to improve the healing of Achilles tendon injuries, but there is debate about the effectiveness of this therapy. The objective of the present study was to evaluate the histological effects of PRGF, which is a type of leukocyte-poor platelet-rich plasma, on tendon healing.

Methods: 

The Achilles tendons of twenty-eight sheep were divided surgically. The animals were randomly divided into four groups of seven animals each. The repaired tendons in two groups received an infiltration of PRGF intraoperatively and every week for the following three weeks under ultrasound guidance. The tendons in the other two groups received injections with saline solution. The animals in one PRGF group and one saline solution group were killed at four weeks, and the animals in the remaining two groups were killed at eight weeks. The Achilles tendons were examined histologically, and the morphometry of fibroblast nuclei was calculated.

Results: 

The fibroblast nuclei of the PRGF-treated tendons were more elongated and more parallel to the tendon axis than the fibroblast nuclei of the tendons in the saline solution group at eight weeks. PRGF-treated tendons showed more packed and better oriented collagen bundles at both four and eight weeks. In addition to increased maturation of the collagen structure, fibroblast density was significantly lower in PRGF-infiltrated tendons. PRGF-treated tendons exhibited faster vascular regression than tendons in the control groups, as demonstrated by a lower vascular density at eight weeks.

Conclusions: 

PRGF was associated with histological changes consistent with an accelerated early healing process in repaired Achilles tendons in sheep after experimental surgical disruption. PRGF-treated tendons showed improvements in the morphometric features of fibroblast nuclei, suggesting a more advanced stage of healing. At eight weeks, histological examination revealed more mature organization of collagen bundles, lower vascular densities, and decreased fibroblast densities in PRGF-treated tendons than in tendons infiltrated with saline solution. These findings were consistent with a more advanced stage of the healing process.

Clinical Implications: 

Based on the findings in this animal model, PRGF infiltration may improve the early healing process of surgically repaired Achilles tendons.

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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