Biological augmentation of meniscal repair: a systematic review

Abstract

PurposeOrthopedic literature remains divided on the utility of biologic augmentation to optimize outcomes after isolated meniscal repair. The aim of this systematic review is to analyze the clinical outcomes and re‐operation rates of biologically augmented meniscal repairs. MethodsPubMed, CINAHL, Cochrane, and EMBASE databases were queried in October 2020 for published literature on isolated meniscal repair with biological augmentation. Studies were assessed for quality and risk of bias by two appraisal tools. Patient demographics, meniscal tear characteristics, surgical procedure, augmentation type, post‐operative rehabilitation, patient reported outcome measures, and length of follow‐up were recorded, reviewed, and analyzed by two independent reviewers. ResultsOf 3794 articles, 18 met inclusion criteria and yielded 537 patients who underwent biologic augmentation of meniscal repair. The biologically augmented repair rates were 5.8–27.0% with PRP augmentation, 0.0–28.5% with fibrin clot augmentation, 0.0–12.9% with marrow stimulation, and 0.0% with stem cell augmentation. One of seven studies showed lower revision rates with augmented meniscal repair compared to standard repair techniques, whereas five of seven found no benefit. Three of ten studies found significant functional improvement of biologically augmented repair versus standard repair techniques and six of ten studies found no difference. There was significant heterogeneity in methods for biologic preparation, delivery, and post‐operative rehabilitation protocols. ConclusionPatients reported significant improvements in functional outcomes scores after repair with biological augmentation, though the benefit over standard repair controls is questionable. Revision rates after biologically augmented meniscal repair also appear similar to standard repair techniques. Clinicians should bear this in mind when considering biologic augmentation in the setting of meniscal repair. Level of evidenceIV.

High survival rate after the combination of intrameniscal and intraarticular infiltrations of platelet‐rich plasma as conservative treatment for meniscal lesions

“…This is one of the few studies that provides clinical results for the considerable large number of patients undergoing this type of treatment, with very few clinical studies using this therapy conservatively, and even fewer using an intrameniscal administration route [11,13,39]. Most studies related to the application of orthobiologics to meniscus injuries are regarding their use in augmentation of meniscal repair surgeries [14]. In these procedures, the application of PRP is conducted during the surgical process of meniscal suturing, either by injection or by applying ibrin clots [7].…”

Regarding “Repair Augmentation of Unstable, Complete Vertical Meniscal Tears With Bone Marrow Venting Procedure: A Prospective, Randomized, Double-Blind, Parallel-Group, Placebo-Controlled Study”

“…Some studies showed significant differences in anterior shift and external rotation during anterior tibial translation in ACL-deficient knee. 4,5 We are confident that changes of knee kinematics cause secondary microinjuries to knee structures (i.e., meniscus) 6,7 and thus, in our opinion, interrupt healing of the repaired meniscus.…”

“…Since then, a series of studies have suggested that blood and bone marrow elements may improve meniscal healing. 7,8 In this research, the authors conducted a randomized controlled study to compare the effectiveness of bone marrow elements on meniscus repair and indicated that the bone marrow-venting procedure results in a significant improvement in the rate of meniscus healing (100% vs 76%, P ¼ .0035). However, because of the requirements of close fitting and sealing between the ligament and bone tunnel during ligament reconstruction, the tunnel is blocked when the graft has been fixed, and the marrow elements can no longer be released into the articular cavity; residual elements in the cavity also may be depleted by arthroscopic irrigation fluid and subsequent intra-articular drains.…”

The Effect of Stem Cells on Meniscus Tear Injuries

“…Meniscus is derived from a Greek work known as meniskos which means "crescent", a diminutive of the word mene, which means "moon" [3]. Meniscus injuries are associated with pain, swelling, impairment in function and activity levels as well as early osteoarthritis of the knee joint [4]. All populations are at risk for meniscal tears when an external force is exerted on the knee causing a twist in the knee.…”

“…Annandale performed the first open meniscal tear repair using surgery in 1885. A variety of arthroscopic knee techniques were introduced in 1960 [4]. Until the 1970s the gold standard was seen as total meniscectomy for surgery related to tears in the meniscus.…”