Standardized Preparation and Multi-Site Application of Leukocyte-Poor Platelet-Rich Plasma in Arthroscopic Anterior Cruciate Ligament Reconstruction: A Technical Note with Early Functional Outcomes

Introduction: The role of platelet-rich plasma (PRP) in anterior cruciate ligament (ACL) reconstruction remains controversial due to heterogeneity in preparation and application protocols. This technical note describes a standardized method for preparation of leukocyte-poor (LP) PRP, and its multi-site intraoperative application, along with favorable early functional outcomes in 15 cases. Materials and Methods: LP-PRP was prepared using a double-spin centrifugation technique with deliberate exclusion of the buffy coat to minimize leukocyte content. Approximately 30 mL of autologous blood was processed. PRP was applied at three sites - (1) graft soaking before insertion, injection into (2) femoral and tibial tunnels, and (3) Intra-articular injection after graft fixation. Results: Fifteen patients undergoing arthroscopic ACL reconstruction with hamstring autograft and LP PRP augmentation were evaluated. Early follow-up demonstrated rapid improvement in functional outcomes, with higher Lysholm, International Knee Documentation Committee, and Tegner scores within the initial post-operative period compared to expected recovery timelines. No PRP -related complications were observed. Conclusion: A reproducible protocol for LP-PRP preparation and multi-site delivery may contribute to enhanced early recovery following ACL reconstruction. Standardization of this technique may improve consistency of outcomes.