Platelet-rich plasma (PRP) augmentation does not result in more favourable outcomes in arthroscopic meniscal repair: a meta-analysis

Migliorini, Filippo; Cuozzo, Francesco; Cipollaro, Lucio; Oliva, Francesco; Hildebrand, Frank; Maffulli, Nicola

doi:10.1186/s10195-022-00630-1

Cited by 24 publications

(15 citation statements)

References 69 publications

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“…Finally, the use of hyaluronic acid did not produce any clinical benefit in either group. The inefficacy of intraarticular infiltrations in APM, such as hyaluronic acid and/or platelet rich plasma (PRP), is also supported by previous evidence [5, 12, 13, 15, 20, 28, 29, 32, 38, 45]. Berg et.…”

Section: Discussionsupporting

confidence: 54%

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No evidence in support of arthroscopic partial meniscectomy in adults with degenerative and nonobstructive meniscal symptoms: a level I evidence-based systematic review

Migliorini

Oliva

Eschweiler

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose It is unclear whether the results of arthroscopic partial meniscectomy (APM) are comparable to a structured physical therapy (PT). This systematic review investigated efficacy of APM in the management of symptomatic meniscal damages in middle aged patients. Current available randomised controlled trials (RCTs) which compared APM performed in isolation or combined with physical therapy versus sham arthroscopy or isolated physical therapy were considered in the present systematic review. Methods This systematic review was conducted according to the 2020 PRISMA statement. All the level I RCTs which investigated the efficacy of AMP were accessed. Studies which included elderlies with severe OA were not eligible, nor were those in which APM was combined with other surgical intervention or in patients with unstable knee or with ligaments insufficiency. The risk of bias was assessed using the software Review Manager 5.3 (The Nordic Cochrane Collaboration, Copenhagen). To rate the quality of evidence of collected outcomes, the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used. Results Data from 17 studies (2037 patients) were collected. 48.5% (988 of 2037 patients) were women. The mean age of the patients was 52.7 ± 3.9 years, the mean BMI 27.0 ± 1.3 kg/m2. The current evidence suggests no difference in functional PROMs (quality of the evidence: high), clinical PROMs (quality of the evidence: high), pain (quality of the evidence: high), quality of life (quality of the evidence: high), physical performance measures (quality of the evidence: moderate), and OA progression (quality of the evidence: moderate). Conclusions The benefits of APM in adults with degenerative and nonobstructive meniscal symptoms are limited. The current evidence reports similarity in the outcome between APM and PT. Further long-term RCTs are required to investigate whether APM and PT produce comparable results using validated and reliable PROMs. Moreover, future RCTs should investigate whether patients who might benefit from APM exist, clarifying proper indications and outcomes. High quality investigations are strongly required to establish the optimal PT regimes. Level of evidence Level I.

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Section: Discussionsupporting

confidence: 54%

“…Degenerative meniscal damage is common in adults [ 14 , 27 ]. At present, the optimal management for non-traumatic, degenerative meniscal damage remains controversial [ 8 , 38 ]. Meniscal tears are defined as intrameniscal linear signal penetrating one or both surfaces of the meniscus at magnetic resonance imaging (MRI) [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

No evidence in support of arthroscopic partial meniscectomy in adults with degenerative and nonobstructive meniscal symptoms: a level I evidence-based systematic review

Migliorini

Oliva

Eschweiler

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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“…Consequently, the forest plots demonstrated that the failure rate of meniscus repair treatment in the PRP group improved significantly compared with that in the non-PRP group. Although a recent meta-analysis on the application of PRP in arthroscopic meniscus repair showed no significant difference in the failure rate [ 43 ], only three studies on the failure rate were included [ 19 , 30 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

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

Feng

2022

J Orthop Surg Res

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Background There is conflicting clinical evidence whether platelet-rich plasma (PRP) therapies could translate to an increased meniscus healing rate and improved functional outcomes. The objective of this systematic review and meta-analysis was to compare the failure rate and patient-reported functional outcomes in meniscus repair augmented with and without PRP. Methods We comprehensively searched the PubMed, Web of Science, Medline, Embase, and Cochrane Library databases to identify studies that compared the clinical efficacy of meniscus repair performed with PRP versus without PRP. The primary outcome was the meniscus repair failure rate, while the secondary outcomes were knee-specific patient-reported outcomes, including the International Knee Documentation Committee (IKDC) score, Lysholm knee scale, visual analog scale, Tegner activity level score, Western Ontario and McMaster Universities Osteoarthritis Index score, Single Assessment Numeric Evaluation score, and Knee injury and Osteoarthritis Outcome Score. Furthermore, subgroup analyses were performed by stratifying the studies according to the PRP preparation technique to investigate the potential sources of heterogeneity among studies. Results Our meta-analysis included nine studies (two RCTs and seven non-RCTs) with 1164 participants. The failure rate in the PRP group was significantly lower than that in the non-PRP group [odds ratio: 0.64, 95% confidence interval (CI) (0.42, 0.96), P = 0.03]. Furthermore, the PRP group was associated with a statistically significant improvement in the visual analog scale for pain [Mean difference (MD): − 0.76, 95% CI (− 1.32, − 0.21), P = 0.007] and Knee injury and Osteoarthritis Outcome Score-symptom [MD: 8.02, 95% CI (2.99, 13.05), P = 0.002] compared with the non-PRP group. However, neither the IKDC score nor the Lysholm knee scale showed any differences between the two groups. In addition, the results of subgroup analyses favored PRP over platelet-rich fibrin matrix (PRFM) regarding the IKDC score. Conclusions Although meniscus repairs augmented with PRP led to significantly lower failure rates and better postoperative pain control compared with those of the non-PRP group, there is insufficient RCT evidence to support PRP augmentation of meniscus repair improving functional outcomes. Moreover, PRP could be recommended in meniscus repair augmentation compared with PRFM. PRFM was shown to have no benefit in improving functional outcomes.

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“…9 Studies evaluating PRP for augmentation of meniscus repair have reported variable outcomes, with some studies reporting improved healing 10,11 while other studies report no effect. 12 PRP has also been evaluated for augmentation of anterior cruciate ligament (ACL) graft healing in a bone tunnel and to improve ACL graft maturation and remodeling; however, most studies have not reported a positive effect. 13 A summary of AAOS Clinical Practice Guidelines related to orthobiologics is presented in Table 1.…”

Section: Platelet-rich Plasmamentioning

confidence: 99%

Orthobiologics: Current Status in 2023 and Future Outlook

Rodeo

2023

J Am Acad Orthop Surg

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Orthobiologic agents, including platelet-rich plasma, connective tissue progenitor cells derived from bone marrow, adipose, and other tissues, and purified cytokines and small peptides, have tremendous potential to target deficiencies in soft-tissue healing. The principal limitation currently is the variability in the composition and biologic activity of orthobiologic formulations, making it difficult to choose the optimal treatment for a specific tissue or pathology. Current data suggest that orthobiologics are "symptom-modifying," but there is little evidence that they can lead to true tissue regeneration ("structure-modifying"). A critically important need at this time is to identify sentinel markers of potency and biologic activity for different orthobiologic formulations so that we can match the treatment to the desired biologic effect for a specific tissue or pathology. Improved understanding of the underlying cellular and molecular mechanisms of tissue degeneration and repair will allow a precision medicine approach where we can choose the optimal orthobiologic treatment of specific orthopaedic problems. It is important for the clinician to be aware of the evolving regulatory status of orthobiologic treatments. Emerging therapies such as the use of exosomes and gene therapy approaches hold great promise as improved methods to both treat symptoms and affect tissue regeneration.

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Platelet-rich plasma (PRP) augmentation does not result in more favourable outcomes in arthroscopic meniscal repair: a meta-analysis

Cited by 24 publications

References 69 publications

No evidence in support of arthroscopic partial meniscectomy in adults with degenerative and nonobstructive meniscal symptoms: a level I evidence-based systematic review

No evidence in support of arthroscopic partial meniscectomy in adults with degenerative and nonobstructive meniscal symptoms: a level I evidence-based systematic review

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

Orthobiologics: Current Status in 2023 and Future Outlook

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