Clinical Outcomes of Meniscus Repair with or without Multiple Intra-Articular Injections of Platelet Rich Plasma after Surgery

Abstract

Preservation of the meniscal volume is crucial in meniscus repair. The goal of this study was to evaluate the clinical outcome of repeated intra-articular platelet-rich plasma (PRP) injections after arthroscopic repair of a traumatic meniscal tear. We retrospectively reviewed 61 primary meniscal repairs in 61 patients (PRP group: 30; non-PRP: 31) from 2017 to 2018. Patients in the PRP group received repeated intra-articular PRP injections in week 2,4,6 after the primary meniscus repair. Subsequent meniscal repair treatment or meniscectomy, knee arthroplasty, and IKDC changes of less than 11.5 points were defined as healing failures. After following up for at least 24 months, the IKDC score was 75.1 ± 13.6, and the Lysholm score was 80.6 ± 14.9 in the PRP group and 72.6 ± 15.8 (IKDC) and 77.7 ± 17.2 (Lysholm) in the non-PRP group. Healing rates of the PRP and the non-PRP groups were 93.3% (Kaplan-Meier 91.6%) and 87.1% (Kaplan-Meier 84.7%), respectively (log rank test p = 0.874). Our study is the first to use multiple intra-articular PRP injections to facilitate meniscal healing after meniscal repair. Though selection bias may be present in this study, the PRP group had similar functional outcome and healing rate compared to non-PRP group.

Platelet-rich plasma use in meniscus repair treatment: a systematic review and meta-analysis of clinical studies

“…After removing 88 duplicate studies, a total of 116 records were excluded because they were deemed irrelevant according to the title and abstract. After thoroughly reviewing the full texts of the 16 potentially eligible articles, nine articles (two RCTs and seven non-RCTs) were selected for the final analysis, which were published between 2015 and 2021 [ 19 , 20 , 25 , 26 , 30 – 34 ]. A flowchart depicting the study selection strategy is shown in Fig.…”

“…We identified six studies in which PRP was delivered arthroscopically and sutured or injected into the repair site [ 19 , 20 , 25 , 31 – 33 ], one study with in situ PRP injection into the repaired lesion after mini-arthrotomy [ 30 ], one study with multiple intra-articular PRP injections after meniscus repair surgery [ 26 ], and one study with minimally invasive (percutaneous) intrameniscal PRP application [ 34 ]. Furthermore, there were seven studies using LR-PRP, with two other studies not specifying LR versus LP formulations [ 20 , 26 ]. Two studies utilized PRP with a fibrin matrix [ 20 ] or clot [ 32 ] that was inserted into the repair site.…”

“…The results of the NOS for the quality of the seven non-RCTs are presented in Table 2 . Five studies were graded as good [ 19 , 25 , 26 , 30 , 32 ] and two graded as fair [ 20 , 33 ]. In particular, the studies by Griffin et al and Everhart et al [ 20 , 33 ] were deemed problematic because they lacked the representativeness of the cases and did not take adequate actions to avoid bias in the study analysis.…”

“…A total of 708 patients from seven studies were considered to display repair failure when they developed a recurrence of meniscal symptoms and requirement for reoperation, or this was shown when evaluated by second-look arthroscopy or MRI postoperatively [ 19 , 20 , 26 , 30 , 31 , 33 , 34 ]. In the PRP group, 16.7% of patients experienced treatment failure, while in the control group, this was 21.6%.…”

“…Although there have been three published systematic review studies on PRP augmentation in meniscus repair treatment [ 22 – 24 ], their major limitations were that they included only a few studies with a limited number of patients as well as studies with heterogeneity of different PRP preparations. Therefore, the aim of present investigation was to systematically review and perform a meta-analysis of the literature to investigate PRP efficacy in meniscus repair, including the most recent matched case–control studies [ 25 , 26 ]. In addition, different forms of PRP preparations were evaluated by subgroup analyses.…”