Purpose
To systematically review the literature on meniscal repair surgery and assess functional
and radiographic outcomes of platelet-rich plasma (PRP)–augmented repair compared
with standard repair techniques.
Methods
A systematic review of the literature was completed according to Preferred Reporting
Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines using the PubMed,
MEDLINE, Embase, and Cochrane databases. The inclusion criteria included all human
studies testing PRP augmentation of meniscal repair written in the English language.
All cadaveric, animal, and basic science studies were excluded from review. The quality
of the included publications was assessed prior to data extraction through the Jadad
score. Risk of bias was further determined by Methodological Index for Non-randomized
Studies (MINORS) and Cochrane risk-of-bias assessments. Heterogeneity in outcomes
reported across studies was evaluated using I2 statistic calculations.
Results
A total of 5 studies (1 with Level I evidence; 1, Level II; and 3, Level III) met
the inclusion criteria for this review, all comparing PRP augmentation of meniscal
repair surgery versus meniscal repair with no augmentation. Overall quality and risk
of bias in the included studies varied substantially (Jadad score, 1-5; Methodological
Index for Non-randomized Studies score, 7-18). Three comparative studies found no
significant difference in outcome or failure, whereas the other two showed a significant
improvement in PRP-augmented repairs at final follow-up. Two studies assessed healing
with postoperative magnetic resonance imaging or second-look arthroscopy, with both
showing significantly improved outcomes in the PRP-treated groups (P < .01 and P = .048). PRP preparation techniques and composition differed among all studies and
were inconsistently reported.
Conclusions
In early and limited investigations, there is insufficient evidence to support PRP
augmentation of meniscal repair surgery improving functional and radiographic outcomes
and resulting in lower failure rates compared with standard repair techniques. There
is considerable heterogeneity in the reporting and preparation of PRP used for augmentation.
Level of Evidence
Level III, systematic review of Level I to III studies.
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Article info
Publication history
Published online: February 10, 2020
Accepted:
January 18,
2020
Received:
September 3,
2019
Footnotes
See commentary on page 1775
The authors report that they have no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2020 by the Arthroscopy Association of North America
ScienceDirect
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- Editorial Commentary: Platelet-Rich Plasma and Knee Meniscal Repair—The Use of Biologics Has Not Progressed Substantially Since 1983ArthroscopyVol. 36Issue 6
- PreviewWhen it comes to meniscal repair, optimizing the local biological environment at the repair site by performing trephination to create bleeding from the extracapsular capillary network, by rasping to abrade the local synovial tissue, or by creating bleeding from the intercondylar notch is recommended. The addition of platelet-rich plasma probably also helps, especially absent the bleeding when meniscal repair is performed concomitantly with anterior cruciate ligament reconstruction. However, pending future research, there is not enough data to recommend platelet-rich plasma augmentation for meniscal repair in all cases.
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