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

Abstract

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.

A bibliometric and visualized analysis of meniscus suture based on the WOS core collection from 2010 to 2022: A review

“…[24,45] Therefore, many novel techniques were implemented to stimulate meniscus regeneration and to increase the healing capacity after meniscus suture, such as platelet-rich plasma (PRP) and autologous growth factors. [46,47] Although meniscus root tears account for only 10% to 20% of all meniscus tears, “meniscus root tear” was still the research highlight in the field of meniscus suture due to subsequent impairment of meniscus and a study conducted by Allaire demonstrated that medial meniscal root tears are equivalent to subtotal medial meniscectomy. [13,48] Furthermore, meniscus repairs resulted better outcomes in meniscus root tears than other treatments.…”

Repair of a Radial Tear of the Meniscus Augmented With a Biocomposite Scaffold

“…This would aim to improve cellular integration, vascularization, matrix deposition, and inflammation reduction at the meniscus repair site. 8 Notably, the application of PRP, 3 fibrin clots, 4 , 5 marrow stimulation, 6 and MSCs 7 has shown promising results on the basic science level. 13 , 14 , 15 Following repair with biological augmentation, patients have reported significant improvement in functional outcome scores.…”

“…Recent efforts have been made to enhance the healing potential of meniscal repairs. Biologic augmentations, such as platelet-rich plasma (PRP), 3 fibrin clots, 4 , 5 marrow stimulation, 6 and mesenchymal stem cells (MSCs), 7 have shown promising results. 8 These interventions have revealed the ability to promote fibrocyte proliferation, extracellular matrix deposition, and neomeniscal tissue formation, highlighting their potential for improving meniscal repair outcomes.…”

Fibrochondrogenic Differentiation Potential of Human Adiposederived Mesenchymal Stem Cells in a Type I Collagen-based Meniscus Scaffold with Activated Platelet-Rich Plasma Stimulation In-vitro

“…Acute symptomatic tears are typically managed conservatively with rest, ice, elevation and oral non-steroidal antiinflammatory medications. Recent research has shown that supervised physical therapy focused on strengthening the muscle groups around the knee (particularly the quadriceps muscles) results in the same clinical outcomes as the most common operation for meniscus tears, an Arthroscopic Partial Meniscectomy (APM) [6][7][8]. Therefore, surgical management of meniscal tears is mostly indicated for patients who don't respond to conservative treatments, have diminished quality of life or have concurrent anterior cruciate ligament injuries.…”

“…There is a lack of large-scale clinical evidence demonstrating its efficacy in accelerating healing when administered in conjunction with physical therapy, surgery or both. However, a recent meta-analysis study found that PRP leads to a significant reduction in meniscectomy failure rates and improved overall functional outcomes in patients who received PRP with surgery compared to their non PRP treated counterparts [6].…”