Background: The effect of platelet-rich plasma (PRP) on the risk of meniscal repair failure is unclear. Current evidence is limited to small studies without comparison between isolated repairs and meniscal repairs with concomitant anterior cruciate ligament (ACL) reconstruction. It is also unclear whether the efficacy of PRP differs between preparation systems in the setting of meniscal repair. Purpose: (1) To determine whether intraoperative PRP affects the risk of meniscal repair failure. (2) To determine whether the effect of PRP on meniscal failure risk is influenced by ACL reconstruction status or by PRP preparation system. Study Design: Cohort study; Level of evidence, 3. Methods: The study entailed 550 patients (mean ± SD age, 28.8 ± 11.2 years) who underwent meniscal repair surgery with PRP (n = 203 total; n = 148 prepared with GPS III system, n = 55 prepared with Angel system) or without PRP (n = 347) and with (n = 399) or without (n = 151) concurrent ACL reconstruction. The patients were assessed for meniscal repair failure within 3 years. The independent effect of PRP on the risk of meniscal repair failure was determined by multivariate Cox proportional hazards modeling with adjustment for age, sex, body mass index, ACL status, tear pattern, tear vascularity, repair technique, side (medial or lateral), and number of sutures or implants used. Results: Failures within 3 years occurred in 17.0% of patients without PRP and 14.6% of patients with PRP ( P = .60) (Angel PRP, 15.9%; GPS III PRP, 14.2%; P = .58). Increased patient age was protective against meniscal failure regardless of ACL or PRP status (per 5-year increase in age: adjusted hazard ratio [aHR], 0.90; 95% CI, 0.81-1.0; P = .047). The effect of PRP on meniscal failure risk was dependent on concomitant ACL injury status. Among isolated meniscal repairs (20.3% failures at 3 years), PRP was independently associated with lower risk of failure (aHR, 0.18; 95% CI, 0.03-0.59; P = .002) with no difference between PRP preparation systems ( P = .84). Among meniscal repairs with concomitant ACL reconstruction (14.1% failures at 3 years), PRP was not independently associated with risk of failure (aHR, 1.39; 95% CI, 0.81-2.36; P = .23) with no difference between PRP preparation systems ( P = .78). Conclusion: Both PRP preparations used in the current study had a substantial protective effect in terms of the risk of isolated meniscal repair failure over 3 years. In the setting of concomitant ACL reconstruction, PRP does not reduce the risk of meniscal repair failure.

Osteochondral allograft (OCA) transplantation is a versatile treatment option for patients with cartilage and osteochondral defects. Indications for this procedure include young active patients with large focal defects, failure of previous cartilage repair, osteonecrosis, osteochondritis dissecans, and/or posttraumatic osteochondral defects.» OCA transplantation is a uniquely useful treatment option for patients with large high-grade osteochondral defects and for athletes who have substantial incentives to return to sport as quickly as possible.Disclosure: The authors indicated that no external funding was received for any aspect of this work. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked "yes" to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work (http://links.lww.com/ JBJSREV/A457).

When compared to meniscectomy, meniscus allograft transplantation (MAT) may provide superior long-term benefits to young, active patient populations who have lost meniscal function because of irreparable damage, such as, an avascular tear, previous repair failure, and unsalvageable tear types. Positive outcomes are most likely to be achieved when meniscus allograft transplantation is performed in appropriately selected patients. Indications include patients younger than 50 years of age, with a history of subtotal or total meniscectomy without concomitant articular cartilage defects, uncorrectable joint malalignment, and/or knee instability. Outcomes for meniscal allograft transplantation are promising with studies reporting long-term graft survivorship as high as 89% at 10 years and significant improvements in multiple patient reported outcome measures. Level of evidence Level V.

Purpose: To quantify healing rates and patient-reported outcome scores following repair of radial meniscus tears. Methods: PubMed, Scopus, and Embase databases were searched according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria included: human subjects with meniscal tears, fulltext English language, average follow-up of at 1 year, and publication after the 2000. Exclusion criteria included technical, biomechanical, and cadaveric studies. Study quality was assessed using Coleman Methodology Scores and Methodological Index for Non-Randomized Studies (MINORS) criteria. Results: Twelve studies reported on the repair of 243 radial tears in 241 patients. The mean Modified Coleman Methodology Score was 46.8, range 26-60, with a mean level of evidence of 3.5. Arthroscopic techniques were used in all studies, with 1 study using an arthroscopic-assisted 2-tunnel transtibial pullout technique. The mean patient age was 32 years (11-71). The mean follow-up was 35 months (12 to 75.6). The average time to surgery was 10.9 months (0.5-22.4). Eight of the 12 studies reported concomitant anterior cruciate ligament (ACL) reconstruction, with 64% having concomitant ACL injury. The most common outcome measure was the Lysholm score, which improved from 47-68.9 preoperatively to 86.4-95.6 postoperatively. Tegner Activity Scale improved from 2.5-3.1 preoperatively to 4.7-6.7 postoperatively. Healing rates were reported via magnetic resonance imaging and second-look arthroscopy. Second-look arthroscopy was performed for a variety of indications, including removal of screw, washers or plates, dissatisfaction with original procedure, partial healing found on magnetic resonance imaging, or desire of the patient to know the true healing status before return to sport. Of those assessed, 62.0% had complete healing, 30.0% partial healing, and 8.0% failure to heal. Conclusions: Patient-reported outcomes of radial meniscus repair with and without ACL reconstruction are encouraging, with high patient-reported outcomes reported at final follow-up when compared with preoperative scores. Among all meniscus repairs assessed for healing, the majority demonstrated at least some healing with an overall low rate of failure. Level of Evidence: IV; systematic review of level III-IV studies.

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PurposeThe purpose of this study was to investigate the impact of articular cartilage damage on outcomes following medial patellofemoral ligament (MPFL) reconstruction. MethodsRecord review identified 160 patients who underwent isolated MPFL reconstruction at a single institution between 2008 and 2016. Patient demographics, patellofemoral articular cartilage status at surgery, and patient anatomical measures from imaging were obtained via chart review. Patients were contacted and outcomes assessed through collection of Norwich Patellar Instability (NPI) score, Knee injury and Osteoarthritis Outcome Score (KOOS), and Marx activity score as well as an assessment for recurrent patellar dislocation. Outcomes of patients with grade 0–II patellofemoral cartilage damage were compared to those of patients with grade III–IV cartilage damage. ResultsOne hundred twenty‐two patients (76%) with a minimum of one year follow‐up were contacted at a mean of 4.8 years post‐operatively. A total of 63 patients (52%) had grade III or IV patellofemoral chondral damage at the time of surgery. The majority of the defects was on the medial patella (46 patients‐72%) and the mean patellar defect size was 2.8 cm2. Among 93 patients who completed patient‐reported outcome scores, the 52 with grade III or IV chondral damage reported a significantly poorer KOOS Quality of Life than the 44 patients with grade 0 to II chondral damage (p = 0.041), controlling for patient age, sex, BMI, and anatomical factors. ConclusionPatients with grade III or IV articular cartilage damage of the patellofemoral joint at the time of MPFL reconstruction demonstrated poorer KOOS knee‐related quality of life than patients without grade III or IV articular cartilage damage at a mean of 4.8 years following isolated MPFL reconstruction. Level of evidenceLevel II

Objectives: Lower limb malalignment causes differences in tibiofemoral contact pressures and may influence outcomes following meniscal repair. Our objective was to evaluate clinical outcomes of meniscal repair in malaligned knees to determine if limb malalignment portends an inferior outcome. We hypothesized that medial meniscus repairs performed in varus knees and lateral meniscus repairs performed in valgus knees would result in poorer patient-reported outcomes when compared to a neutrally aligned knee. Methods: Patients who underwent meniscal repair at a single institution between 2006 and 2018 were identified by retrospective chart review. Patients between the ages of 18 and 65 with full-length weight bearing lower limb radiographs were included. Patients with varus alignment (> 3 degrees) and a medial meniscus repair, or valgus alignment (>3 degrees) and a lateral meniscus repair were considered “at-risk”. Outcomes were assessed through identification of additional surgery on the index meniscus and patient-reported outcome measures (PROMs): Knee Injury and Osteoarthritis Outcome Score (KOOS), Marx activity score, and International Knee Documentation Committee subjective score (IKDC). Failure rates and PROMs were compared between the at-risk and not at risk groups. Results: A total of 58 patients were included with a mean follow-up of 1.6 years. A total of 12 patients were classified as “at-risk”. Repeat surgery on the index meniscus was performed in 1 of 12 “at risk” patients (8.3%) and 7 of 46 (15.2%) in the “not at risk” group (p = 1.00). There were no significant differences between the two groups in KOOS subscales: pain (82.8 vs 85.6, p = 0.55), symptoms (78.2 vs 80.8, p = 0.64), ADLs (88.4 vs 92.9, p = 0.27), Sport/Rec Function (63.8 vs 69.2, p = 0.57), or QOL (58.9 vs 62.3, p = 0.69). There was also no difference in IKDC score (66.9 vs 72.5, p = 0.41) or Marx score (4.2 vs 5.0, p = 0.63) between the two groups. Conclusions: Pre-operative knee malalignment does not appear to negatively influence clinical outcomes of meniscal repair when compared to normal knee alignment. [Table: see text]