Abstract
Purpose
Orthopedic literature remains divided on the utility of biologic augmentation to optimize outcomes after isolated meniscal repair. The aim of this systematic review is to analyze the clinical outcomes and re-operation rates of biologically augmented meniscal repairs.
Methods
PubMed, CINAHL, Cochrane, and EMBASE databases were queried in October 2020 for published literature on isolated meniscal repair with biological augmentation. Studies were assessed for quality and risk of bias by two appraisal tools. Patient demographics, meniscal tear characteristics, surgical procedure, augmentation type, post-operative rehabilitation, patient reported outcome measures, and length of follow-up were recorded, reviewed, and analyzed by two independent reviewers.
Results
Of 3794 articles, 18 met inclusion criteria and yielded 537 patients who underwent biologic augmentation of meniscal repair. The biologically augmented repair rates were 5.8–27.0% with PRP augmentation, 0.0–28.5% with fibrin clot augmentation, 0.0–12.9% with marrow stimulation, and 0.0% with stem cell augmentation. One of seven studies showed lower revision rates with augmented meniscal repair compared to standard repair techniques, whereas five of seven found no benefit. Three of ten studies found significant functional improvement of biologically augmented repair versus standard repair techniques and six of ten studies found no difference. There was significant heterogeneity in methods for biologic preparation, delivery, and post-operative rehabilitation protocols.
Conclusion
Patients reported significant improvements in functional outcomes scores after repair with biological augmentation, though the benefit over standard repair controls is questionable. Revision rates after biologically augmented meniscal repair also appear similar to standard repair techniques. Clinicians should bear this in mind when considering biologic augmentation in the setting of meniscal repair.
Level of evidence
IV.
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Abbreviations
- PRP:
-
Platelet-rich plasma
- MSC:
-
Mesenchymal stem cells
- BMP:
-
Bone morphogenic protein
- PRISMA:
-
Preferred Reporting Items for Systematic Review and Meta Analysis
- MCMS:
-
Modified Coleman Methodology Score
- JBI:
-
Joanna Briggs Institute
- VAS:
-
Visual Analog Scale
- IKDC:
-
International Knee Documentation Committee
- TAS:
-
Tegner Activity Score
- DVT:
-
Deep vein thrombosis
- CRP:
-
C-reactive protein
- LOE:
-
Level of evidence
- Mos:
-
Months
- MS:
-
Marrow stimulation
- SC:
-
Stem cells
- Wk/wks:
-
Week/weeks
- NWB:
-
Non-weight-bearing
- WBAT:
-
Weight-bearing as tolerated
- PWB:
-
Partial weight-bearing
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RK was the primary author of the manuscript and primary reviewer. EAO developed the concept and search strategy and assisted in manuscript drafting and review, as well as served as the discordant reviewer. GM was the secondary literature reviewer. TC and OS aided in manuscript preparation and editing. SL performed statistical analysis and table design. LSO oversaw and provided senior support as well as editing of the manuscript. All authors read and approved the final manuscript.
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Keller, R.E., O’Donnell, E.A., Medina, G.I.S. et al. Biological augmentation of meniscal repair: a systematic review. Knee Surg Sports Traumatol Arthrosc 30, 1915–1926 (2022). https://doi.org/10.1007/s00167-021-06849-5
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DOI: https://doi.org/10.1007/s00167-021-06849-5