Role of Platelet-Rich Plasma in Preventing Tunnel Widening in Anterior Cruciate Ligament Reconstruction: A Clinical Study

Background: Tunnel widening is a common complication after anterior cruciate ligament (ACL) reconstruction, potentially affecting graft stability and revision outcomes. Platelet-rich plasma (PRP), due to its growth factors, may enhance bone–graft healing and reduce tunnel enlargement. Objective: This study aimed to evaluate the effect of PRP on tunnel widening post-ACL reconstruction. Materials and Methods: A prospective study was conducted on 16 patients (aged 15–45 years) undergoing ACL reconstruction using hamstring grafts soaked in autologous PRP. Additional PRP was injected intra-articularly and into the tibial and femoral tunnels. Postoperative magnetic resonance imaging assessed tunnel diameters at specific femoral and tibial points. Tunnel widening was graded into four categories: no, borderline, clear, and massive. Results: Femoral tunnel widening was mostly borderline (entry: 68.8% and mid: 81.3%), with no massive enlargement observed. Tibial tunnel widening was more pronounced, with 18.8% showing massive entry enlargement. Mean tunnel diameters were 2.02 mm (femur entry), 1.79 mm (femur mid), and 3.24 mm (tibia entry). Conclusion: PRP may reduce femoral tunnel widening in ACL reconstruction, especially mid-tunnel, but shows limited effect on the tibial side. Larger controlled studies are needed to validate these findings.