Platelet-Rich Plasma Augmentation of Meniscal Repair in the Setting of Anterior Cruciate Ligament Reconstruction

Abstract

Background: The increasing incidence of anterior cruciate ligament (ACL) and meniscal injuries has led to strong interest in discovering new methods to enhance the biological healing response of these tissues. Platelet-rich plasma (PRP) contains various growth factors associated with a positive healing response, but few existing clinical studies are available to determine the risks and benefits of these therapies. Purpose: To determine the effects of intraoperative PRP on postoperative knee function and complications at 2 years after ACL reconstruction with meniscal repair. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective matched case-control study was conducted between 2013 and 2017 using a single surgeon database of 1014 patients undergoing primary ACL reconstruction with concomitant meniscal repair, resulting in 324 patients (162 PRP patients and 162 control patients) who met the study criteria. Patients were matched by age, sex, graft type, and meniscal injury. The Single Assessment Numeric Evaluation (SANE) was administered at 2 years, and injury surveillance was conducted. Secondary outcomes included the time to return to activity (months), self-reported knee function (International Knee Documentation Committee [IKDC] score), functional performance testing (knee range of motion, single-leg balance, single-leg hopping, agility testing), and postoperative complications (graft failure, infection, loss of motion [requiring repeat arthroscopy for lysis of adhesions], venous thrombosis, etc). Univariate models were used for between-group comparisons, and alpha was set at .05 for all analyses. Results: No differences were found in SANE knee function scores between the PRP and matched-control groups at 2 years (91.6 ± 11.2 vs 92.4 ± 10.6, respectively; P = .599). Additionally, no differences were reported between groups for self-reported function (IKDC score, 87.6 ± 13.3 vs 88.1 ± 12.6; P = .952), functional performance testing ( P > .05), and timing of return to activity (7.8 ± 1.9 vs 8.0 ± 1.9 months; P = .765). The PRP group demonstrated a higher rate of postoperative knee motion loss compared with the control group (13.6% vs 4.6%; P < .001). No other differences were observed in postoperative complications ( P > .05). Conclusion: The added use of intraoperative PRP did not improve self-reported knee function, functional performance, and timing of return to activity for patients undergoing ACL reconstruction with meniscal repair. Furthermore, the use of PRP may have negative consequences for regaining knee range of motion after surgery. On the basis of these data, surgeons should cautiously consider the application of PRP when planning surgery for intra-articular injuries of the knee. Registration: NCT03704376 ( ClinicalTrials.gov identifier).

Anterior Cruciate Ligament Reconstruction: Is Biological Augmentation Beneficial?

“…The use of PRP also had negative consequences in terms of the postoperative recovery of knee range of motion. Based on these data, the authors stated that orthopedic surgeons should cautiously consider the application of PRP during surgery for intra-articular knee injuries [18]. In a systematic review and meta-analysis published in 2021, Lv et al concluded that the use of PRP could significantly decrease pain in the short term but not in the long term [80].…”

“…It is important to highlight the discrepancy between 2 recent articles: one on an experimental study stating that orthobiologics can accelerate biological events related to tendon allograft incorporation [72] and another on a clinical study on meniscal repair in the ACLR setting stating that the added use of intraoperative PRP does not improve the analyzed parameters (self-reported knee function, functional performance, and time to return to previous activity). According to Hexter et al, the use of PRP might have negative consequences for the postoperative recovery of knee range of motion [18].…”

“…Numerous types of mesenchymal stem cells (MSCs) have been reported to enhance healing at the graft-tunnel interface in experimental studies (animal models). Such cells can be isolated during surgery through bone marrow aspiration or cultured prior to surgery [18]. Table 2 summarizes the different types of stem cells used in ACLR [18][19][20][21][22][23][24][25][26].…”

“…Such cells can be isolated during surgery through bone marrow aspiration or cultured prior to surgery [18]. Table 2 summarizes the different types of stem cells used in ACLR [18][19][20][21][22][23][24][25][26].…”

“…Current evidence indicates that when the ACL ruptures, locally released CD34+ vascular MSCs contribute to the rupture's healing [18]. An important advantage of employing autologous tissue rather than cultured MSCs is the ability of autologous tissue to provide a source of regenerative cells without risk of rejection or malignancy.…”