Augmentation of Meniscal Repair With Platelet-Rich Plasma: A Systematic Review of Comparative Studies

Abstract

Background: The effect of platelet-rich plasma (PRP) augmentation for meniscal repair (MR) is unclear, as current evidence is limited to small, mostly nonrandomized studies. Purpose: To systematically review the literature to evaluate the efficacy and safety of MR with PRP augmentation. Study Design: Systematic review; Level of evidence, 3. Methods: A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to identify studies (level of evidence 1-3) that compared the clinical efficacy of MR performed with versus without PRP. The search phrase used was platelet-rich plasma meniscus. Patients were assessed based on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the visual analog scale (VAS) for pain, the Lysholm score, the Knee injury and Osteoarthritis Outcome Score (KOOS), the subjective International Knee Documentation Committee (IKDC) score, and treatment failure. Results: We identified 6 studies (2 studies with level 1 evidence; 4 studies with level 3 evidence) that met inclusion criteria, for a total of 309 patients undergoing MR with PRP (mean age, 31.9 years) and 445 patients without PRP augmentation (mean age, 29.6 years). The mean follow-up was 32.8 months (range, 12-72 months). Overall, 17.0% of PRP patients experienced MR failure compared with 22.1% of non-PRP patients. No differences in VAS, Lysholm, or subjective IKDC scores were found between groups except in 1 study, in which postoperative subjective IKDC scores were significantly better in the PRP group ( P < .01). Another study found significantly better postoperative WOMAC scores among PRP patients, and 2 studies found significantly better KOOS subscores among PRP patients. Conclusion: There are a limited number of high-quality studies comparing outcomes and healing rates between patients undergoing MR with versus without PRP augmentation. Based on the available evidence, patients undergoing MR with PRP augmentation experience similar clinical outcomes at midterm follow-up when compared with conventional MR, and additional studies are needed to determine the efficacy of MR augmented with PRP.

Biologic Augmentation Reduces the Failure Rate of Meniscal Repair: A Systematic Review and Meta-analysis

“…Nevertheless, the low number of recently published studies underlines that the field of meniscal-repair augmentation is still in its infancy and is experiencing a rapid development. In fact, to date, results are still very controversial, and 2 recent systematic reviews concluded that patients undergoing meniscal repair with PRP augmentation experience clinical outcomes similar to those of conventional meniscal repair 4 and that the available evidence is insufficient to support the efficacy of PRP augmentation. 25 In particular, the second of these reviews 25 was a study that did not report failure rates and was therefore not included in our meta-analysis.…”

Can platelet-rich plasma enhance the effect of meniscus repair?:a meta-analysis of randomized controlled trials

“…Most studies generally chose a follow-up period of 6 months, and only some studies had a follow-up period of more than 12 months. This may also be the reason for the difference between the results of this review and previous studies [41][42]. According to the evidence in this review, PRP enhances the meniscus, and no side effects were reported, which indicates that PRP is generally well tolerated.…”

Nonoperative and Operative Soft-Tissue and Cartilage Regeneration and Orthopaedic Biologics of the Knee: An Orthoregeneration Network (ON) Foundation Review

“…105 A systematic review of 6 studies including 309 patients undergoing meniscal repair þ PRP augmentation versus 445 patients treated with repair alone reported repair failures in 17% of patients with PRP versus 22.1% of patients without PRP at a mean follow-up of 32.8 months. 105 Kaminski et al 106 reported significant improvements in patients receiving PRP þ repair versus repairs alone. Meniscal healing, evaluated on second-look arthroscopy or MRI, was present in 85% of repairs augmented with PRP versus 47% in the non-PRP group (P ¼ .048).…”

“…The conflicting results in healing rates and PROs can be attributed largely to the differences in PRP formulation, with variable concentrations of platelets, leukocytes, and growth factors. 105…”