A Prospective, Randomized, Double-Blind, Parallel-Group, Placebo-Controlled Study Evaluating Meniscal Healing, Clinical Outcomes, and Safety in Patients Undergoing Meniscal Repair of Unstable, Complete Vertical Meniscal Tears (Bucket Handle) Augmented with Platelet-Rich Plasma

Abstract

Objective The present study aimed to investigate the effectiveness and safety of platelet-rich plasma (PRP) application in arthroscopic repair of complete vertical tear of meniscus located in the red-white zone. Methods This single center, prospective, randomized, double-blind, placebo-controlled, parallel-arm study included 37 patients with complete vertical meniscus tears. Patients received an intrarepair site injection of either PRP or sterile 0.9% saline during an index arthroscopy. The primary endpoint was the rate of meniscus healing in the two groups. The secondary endpoints were changes in the International Knee Documentation Committee (IKDC) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and analog scale (VAS) in the two groups at 42 months. Results After 18 weeks, the meniscus healing rate was significantly higher in the PRP-treated group than in the control group (85% versus 47%, P = 0.048). Functional outcomes were significantly better 42 months after treatment than at baseline in both groups. The IKDC score, WOMAC, and KOOS were significantly better in the PRP-treated group than in the control group. No adverse events were reported during the study period. Conclusions The findings of this study indicate that PRP augmentation in meniscus repair results in improvements in both meniscus healing and functional outcome.

Examination of the Role of Platelet-Rich Plasma in Meniscal Tears

“…The literature search yielded 6 articles. [14][15][16][17][18][19] Most articles comprised active patients with a mean age of 28 to 29 years. The articles include case studies, 1 retrospective cohort study, and 1 longitudinal cohort study.…”

“…Kaminski et al 16 outlined a prospective, randomized, parallelgroup, double-blind, placebo-controlled study examining 37 patients with unstable complete vertical tears in the red-white zone of the meniscus. Patients treated with intraoperative repair and injection of PRP showed an 85% increase in healing rate via secondlook arthroscopy or magnetic resonance imaging at 18 weeks compared with 47% in the control group that received a placebo injection during surgery.…”

“…19 Although the difference in VAS scores between the 2 groups was not significant, the KOOS score improved significantly in the PRP-treated group. 16 Pujol et al 17 year postoperatively, and subsequent meniscectomy (deemed "clinical failure"). Ultimately, functional clinical outcomes were slightly higher in the PRP-group than in the control group seen in median active flexion, IKDC, and KOOS scores.…”

“…This is worth noting, because concomitant anterior cruciate ligament deficiency can negatively affect meniscal healing. 16 Generalizability within the research is lacking, because a larger and more diverse patient population is needed. Case and cohort studies potentially introduce confounding bias, performance bias, reporting bias, recall bias, and selection bias.…”

Novel Approaches in Meniscal Repair Utilizing Mesenchymal Stem Cells, New Generation Bioscaffolds and Biological Adhesives as Cell Delivery Vehicles

“…An alternative approach is the co-culture of MSCs with chondrocytes or meniscal cells to pre-condition these or expand cell numbers prior to their incorporation into bioscaffolds, hydrogels or bioadhesives prior to administration to the meniscal defect [159,164] (Figure 3a and b). Platelet rich plasma or platelet rich fibrin clots have been used to enhance meniscal repair in bioscaffolds [120,[165][166][167][168][169][170][171].…”