Efficacy of platelet-rich plasma in arthroscopic repair for discoid lateral meniscus tears

Abstract

BackgroundTo evaluate the clinical results of arthroscopic repair with or without platelet-rich plasma (PRP) for tears of the discoid lateral meniscus (DLM).MethodsTwenty-nine patients with DLM tears within a stable knee were arthroscopically treated with meniscal suture repair. Of those, 14 were augmented with platelet-rich plasma (PRP), and 15 were performed without PRP augmentation. Patients were evaluated at baseline (the day before surgery) and then 12 and 24 months after the last injection. Evaluation included the Lysholm score, and Ikeuchi grade, Visual analogue score (VAS) for pain and failure rate. Failure was defined by patients developing symptoms of joint line pain, locking, swelling or requiring repeat arthroscopy.ResultsThere was no difference in the failure rate in the PRP group (1 of 14) compared with the non-PRP group (2 of 15) (P = 0.58). Statistically significant improvement in Lysholm score, Ikeuchi grade and VAS for pain was documented at the last follow-up compared with baseline in both PRP and non-PRP group. No significantly difference was found between the PRP group and non-PRP group on Lysholm score, Ikeuchi grade and VAS for pain at the last follow-up. In the univariate analysis of each variable, younger age (P = 0.036) and longer follow-up duration (P = 0.043) were statistically associated with a better function improvement. Whereas in multivariate analysis, only younger age (P = 0.004) was significantly associated with a better function improvement.ConclusionWith regard to clinical evaluations in arthroscopic repair for DLM tears, PRP group had similar effect in pain relief and functional improvement to non-PRP group at mid-term follow-up. Future larger prospective studies with a longer follow-up are needed to determine whether PRP should be used with DLM repair.

The Clinical Use of Platelet-Rich Plasma in Knee Disorders and Surgery—A Systematic Review and Meta-Analysis

“…One study was at high risk of bias for five domains [51], four studies were at high risk of bias for four domains [49,50,52,53], and two studies were at high risk of bias for two domains [47,48]. High risk of performance bias was identified in five studies [49][50][51][52][53] and moderate risk of performance bias was identified in two studies [47,48] (Figure 9C). One study was at high risk of bias for five domains [51], four studies were at high risk of bias for four domains [49,50,52,53], and two studies were at high risk of bias for two domains [47,48].…”

“…Two RCTs [47,48] and five non-randomized studies [49][50][51][52][53] evaluated the use of PRP in meniscus healing. In five studies, PRP was injected after arthroscopic meniscus repair [47,49,50,52,53], in one study patients underwent open meniscal repair with an adjunct of PRP [51], and in another the authors compared percutaneous meniscal trephination with or without PRP [6].…”

“…One study did not provide any objective radiographic outcomes, only commenting "some" MRIs [49]. The pooled estimates for all six studies showed significant differences in favor of PRP (p = 0.0003), but due to the diversity of clinical trial types, synthesis provided only level of evidence III type data (retrospective cohort Six studies reported failure rates of meniscus healing, two randomized studies using MRI and second-look arthroscopy showed significant differences in favor of PRP (p = 0.006) [47,48], and another four non-randomized studies also showed significant differences in favor of PRP (p = 0.02) [50][51][52][53]. In three studies the failure rate was defined by the need for revision surgery [50,52,53] and in the final study, MRI was used to assess meniscus healing [51].…”

“…Functional outcome was also recorded by the Lysholm score in three studies [49,50,53], by the KOOS score in three studies [47,48,51], and by the Tegner score in two studies [49,50].…”

“…High risk of performance bias was identified in five studies [49][50][51][52][53] and moderate risk of performance bias was identified in two studies [47,48] (Figure 9C). One study was at high risk of bias for five domains [51], four studies were at high risk of bias for four domains [49,50,52,53], and two studies were at high risk of bias for two domains [47,48]. High risk of performance bias was identified in five studies [49][50][51][52][53] and moderate risk of performance bias was identified in two studies [47,48] (Figure 9C).…”