{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T23:19:57Z","timestamp":1782170397455,"version":"3.54.5"},"reference-count":30,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T00:00:00Z","timestamp":1765497600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Despite the high rate of donor site morbidity, a bone\u2013patellar tendon\u2013bone (BPTB) graft remains the gold standard when choosing a graft for anterior cruciate ligament (ACL) reconstruction. Damage to the infrapatellar branch of the saphenous nerve (IPBSN) during graft harvesting results in sensory deficits. Despite its high occurrence in the postoperative period, many patients go untreated, leading to a lower quality of life and potential professional impairment. The aim of this study was to assess the effectiveness of PRF therapy in alleviating sensory deficits and enhancing sensory nerve function in patients who have undergone BTB ACL reconstruction. Materials and Methods: This study was registered at ClinicalTrials.gov (Name of registry: ClinicalTrials.gov; Trial registration number: NCT07257666; Date of registration: 2 December 2025; Study start date: 7 January 2022). Over a one-year period, the pilot study enrolled 53 patients, treated them with BPTB ACL reconstruction, and divided them into two groups. The testing group\u2019s donor site and subcutaneous tissue were treated with Vivostat\u00ae PRF, whereas the standard group\u2019s donor site and subcutaneous tissue remained untreated. The primary outcome measured was a reduction in the subjective numbness, which was tested during follow-up checks. Secondary outcomes included the evaluation of subjective knee scores for functional recovery, reported by the patients on control exams. Results: The use of Vivostat\u00ae PRF resulted in a statistically significant reduction in sensory deficit among the groups at eight months (p &lt; 0.05) and twelve months (p &lt; 0.01) following surgery, favoring the testing group. The most substantial decrease in symptomatic patients was observed between four and eight months post-surgery, with no statistically significant difference found between the eight- and twelve-month follow-ups (p &gt; 0.05). Evaluations of subjective knee function and activity scores showed no statistically significant differences between the groups. Conclusions: Using Vivostat\u00ae PRF helps reduce sensory impairment in the area and minimizes donor site morbidity after BPTB ACL reconstruction.<\/jats:p>","DOI":"10.3390\/medicina61122202","type":"journal-article","created":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T14:04:40Z","timestamp":1765548280000},"page":"2202","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Sensory Deficit Following Anterior Cruciate Ligament Reconstruction with Bone\u2013Patellar Tendon\u2013Bone Autograft: Platelet-Rich Fibrin (PRF) Could Provide a Solution"],"prefix":"10.3390","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3873-2587","authenticated-orcid":false,"given":"Darko","family":"Milovanovic","sequence":"first","affiliation":[{"name":"Clinic for Orthopedic Surgery and Traumatology, University Clinical Center of Serbia, Pasterova 2, 11000 Belgrade, Serbia"},{"name":"School of Medicine, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0624-8133","authenticated-orcid":false,"given":"Marko","family":"Kadija","sequence":"additional","affiliation":[{"name":"Euromedik Hospital, Bulevar Umetnosti 29, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dusica","family":"Gavrilovi\u0107","sequence":"additional","affiliation":[{"name":"Institute for Oncology and Radiology of Serbia, Pasterova 14, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7225-4961","authenticated-orcid":false,"given":"Svetlana","family":"Sreckovic","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia"},{"name":"Center for Anesthesiology and Resuscitation, University Clinical Center of Serbia, Pasterova 2, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7848-866X","authenticated-orcid":false,"given":"Miljan","family":"Bilanovic","sequence":"additional","affiliation":[{"name":"University Hospital Medical Center Bezanijska Kosa, Dr Zorza Matea bb, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3023-0478","authenticated-orcid":false,"given":"Aleksandar","family":"Mati\u0107","sequence":"additional","affiliation":[{"name":"Clinic for Orthopedics and Traumatology, University Clinical Centre of Kragujevac, Zmaj Jovina 30, 34000 Kragujevac, Serbia"},{"name":"Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovica 69, 34000 Kragujevac, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3900-4515","authenticated-orcid":false,"given":"Petar","family":"Vukman","sequence":"additional","affiliation":[{"name":"Clinic for Orthopedic Surgery and Traumatology, University Clinical Center of Serbia, Pasterova 2, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1302\/2058-5241.1.160032","article-title":"Anterior cruciate ligament reconstruction: Principles of treatment","volume":"11","author":"Paschos","year":"2016","journal-title":"EFORT Open Rev."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3339","DOI":"10.1007\/s00167-023-07402-2","article-title":"Lower donor site morbidity with hamstring and quadriceps tendon autograft compared with bone-patellar tendon-bone autograft after anterior cruciate ligament reconstruction: A systematic review and network meta-analysis of randomized controlled trials","volume":"31","author":"Kunze","year":"2023","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2325967120925482","DOI":"10.1177\/2325967120925482","article-title":"A Novel Scoring Instrument to Assess Donor Site Morbidity After Anterior Cruciate Ligament Reconstruction With a Patellar Tendon Autograft at 2-Year Follow-up Using Contemporary Graft-Harvesting Techniques","volume":"8","author":"Hacken","year":"2020","journal-title":"Orthop. J. Sports Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1186\/s40634-023-00600-4","article-title":"Current trends in graft choice for anterior cruciate ligament reconstruction\u2014Part I: Anatomy, biomechanics, graft incorporation and fixation","volume":"10","author":"Runer","year":"2023","journal-title":"J. Exp. Orthop."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/j.arthro.2007.08.020","article-title":"The incidence of acute patellar tendon harvest complications for anterior cruciate ligament reconstruction","volume":"24","author":"Lee","year":"2008","journal-title":"Arthroscopy"},{"key":"ref_6","first-page":"557","article-title":"Anatomical Study of the Infrapatellar Branch of the Saphenous Nerve in Humans","volume":"55","author":"Luciano","year":"2020","journal-title":"Rev. Bras. Ortop."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1016\/j.knee.2008.05.002","article-title":"Injury to the infrapatellar branch of the saphenous nerve in ACL reconstruction with the hamstrings technique: Clinical and electrophysiological study","volume":"15","author":"Figueroa","year":"2008","journal-title":"Knee"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"S245","DOI":"10.1016\/j.otsr.2017.09.002","article-title":"Complications following harvesting of patellar tendon or hamstring tendon grafts for anterior cruciate ligament reconstruction: Systematic review of literature","volume":"103","author":"Hardy","year":"2017","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1177\/03635465000280042001","article-title":"The relationship of the infrapatellar branches of the saphenous nerve to arthroscopy portals and incisions for anterior cruciate ligament surgery. An anatomic study","volume":"28","author":"Tifford","year":"2000","journal-title":"Am. J. Sports Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1177\/03635465000280030801","article-title":"Comparison of Traditional and Subcutaneous Patellar Tendon Harvest: A Prospective Study of Donor Site-Related Problems After Anterior Cruciate Ligament Reconstruction Using Different Graft Harvesting Techniques","volume":"28","author":"Kartus","year":"2000","journal-title":"Am. J. Sports Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1016\/j.arthro.2005.02.019","article-title":"The sartorial branch of the saphenous nerve: Its anatomy at the joint line of the knee","volume":"21","author":"Dunaway","year":"2005","journal-title":"Arthroscopy"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"56","DOI":"10.2106\/00004623-197961010-00011","article-title":"The supporting structures and layers on the medial side of the knee: An anatomical analysis","volume":"61","author":"Warren","year":"1979","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1007\/s11845-014-1087-2","article-title":"Anatomic study of infrapatellar branch of saphenous nerve in male cadavers","volume":"184","author":"Kalthur","year":"2015","journal-title":"Ir. J. Med. Sci."},{"key":"ref_14","first-page":"e47176","article-title":"Current Status and Advancements in Platelet-Rich Plasma Therapy","volume":"15","author":"Pretorius","year":"2023","journal-title":"Cureus"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1089\/wound.2014.0581","article-title":"Metalloproteinases and Wound Healing","volume":"4","author":"Caley","year":"2015","journal-title":"Adv. Wound Care"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2325967120902013","DOI":"10.1177\/2325967120902013","article-title":"Does the Application of Platelet-Rich Fibrin in Anterior Cruciate Ligament Reconstruction Enhance Graft Healing and Maturation? A Comparative MRI Study of 44 Cases","volume":"8","author":"Beyzadeoglu","year":"2020","journal-title":"Orthop. J. Sports Med."},{"key":"ref_17","first-page":"1","article-title":"The Antimicrobial Peptide Human Beta-Defensin-3 Is Induced by Platelet-Released Growth Factors in Primary Keratinocytes","volume":"2017","author":"Bayer","year":"2017","journal-title":"Mediat. Inflamm."},{"key":"ref_18","unstructured":"Skarpas, G.A. (2025, April 21). Arthrozheal\u00ae, a Bioactive Fibrin Scaffold for Joint Cartilage, Tendon and Soft Tissue Lesions. Latest Results and Application Perspectives. Available online: https:\/\/surgicaltechnology.com\/41-Orthopaedic-Surgery.htm#1636."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1002\/micr.22105","article-title":"Effect of platelet rich plasma and platelet rich fibrin on sciatic nerve regeneration in a rat model","volume":"33","author":"Lichtenfels","year":"2013","journal-title":"Microsurgery"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1002\/term.1756","article-title":"Effect of platelet-rich plasma (PRP) concentration on proliferation, neurotrophic function and migration of Schwann cells in vitro","volume":"10","author":"Zheng","year":"2016","journal-title":"J. Tissue Eng. Regen. Med."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Lambrichts, I., Wolfs, E., Bronckaers, A., Gervois, P., and Vangansewinkel, T. (2023). The Effect of Leukocyte- and Platelet-Rich Fibrin on Central and Peripheral Nervous System Neurons\u2014Implications for Biomaterial Applicability. Int. J. Med. Sci., 24.","DOI":"10.3390\/ijms241814314"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"E1321","DOI":"10.1227\/NEU.0b013e31822a9fd2","article-title":"Neurological Recovery Across a 12-cm-Long Ulnar Nerve Gap Repaired 3.25 Years Post Trauma: Case Report","volume":"69","author":"Kuffler","year":"2011","journal-title":"Neurosurgery"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"401","DOI":"10.3233\/THC-2002-10504","article-title":"The Vivostat application system: A comparison with conventional fibrin sealant application systems","volume":"10","author":"Dodd","year":"2002","journal-title":"Technol. Health Care"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1055\/s-0037-1605559","article-title":"Incidence and Characterization of Hypoesthesia in the Distribution of the Infrapatellar Branch of the Saphenous Nerve after Anterior Cruciate Ligament Reconstruction: A Prospective Study of Patient-Reported Numbness","volume":"31","author":"Cohen","year":"2018","journal-title":"J. Knee Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1465","DOI":"10.1007\/s00402-020-03508-1","article-title":"Quadriceps tendon vs. patellar tendon autograft for ACL reconstruction using a hardware-free press-fit fixation technique: Comparable stability, function and return-to-sport level but less donor site morbidity in athletes after 10 years","volume":"140","author":"Sprinckstub","year":"2020","journal-title":"Arch. Orthop. Trauma. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1007\/s00167-011-1570-5","article-title":"Autologous platelet-rich plasma gel to reduce donor-site morbidity after patellar tendon graft harvesting for anterior cruciate ligament reconstruction: A randomized, controlled clinical study","volume":"20","author":"Cervellin","year":"2012","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"ref_27","first-page":"6","article-title":"Quantifying anterior knee pain during specific activities after using the bone-patellar tendon-bone graft for arthroscopic anterior cruciate ligament reconstruction","volume":"15","author":"Kovindha","year":"2019","journal-title":"Asia Pac. J. Sports Med. Arthrosc. Rehabil. Technol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1177\/03635465010290041201","article-title":"Techniques for Reducing Anterior Knee Symptoms after Anterior Cruciate Ligament Reconstruction Using a Bone-Patellar Tendon-Bone Autograft","volume":"29","author":"Tsuda","year":"2001","journal-title":"Am. J. Sports Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1016\/0749-8063(95)90123-X","article-title":"Patellar tendon graft harvesting using horizontal incisions for anterior cruciate ligament reconstruction","volume":"11","author":"Mishra","year":"1995","journal-title":"Arthrosc. J. Arthrosc. Relat. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.otsr.2008.09.006","article-title":"Double-incision mini-invasive technique for BTB Harvesting: Its superiority in reducing anterior knee pain following ACL reconstruction","volume":"95","author":"Gaudot","year":"2009","journal-title":"Orthop. Traumatol. Surg. Res."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/12\/2202\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T14:12:41Z","timestamp":1765548761000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/12\/2202"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,12]]},"references-count":30,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["medicina61122202"],"URL":"https:\/\/doi.org\/10.3390\/medicina61122202","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,12]]}}}