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Platelet-rich plasma for open meniscal repair in young patients: Any benefit?

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Many studies have demonstrated that injection of various growth factors including platelet-derived growth factor could increase meniscal cell activity and stimulate repair. The purpose of this study was to augment repair and promote meniscal healing by the use of platelet-rich plasma (PRP) within horizontal cleavage meniscal tears repaired via an open approach. The hypothesis was that the clinical outcomes and healing process would be improved using this meniscal healing augmentation technique.

Methods

In this case–control study, 34 consecutive young patients underwent an open meniscal repair to treat symptomatic Grade 2 or Grade 3 horizontal meniscal tears [median age 28 years (13–40)]. The median time between the onset of symptoms and surgery was 11.5 months (6–50). In the first group (17 consecutive patients, Group 1), a standard open meniscal repair was performed. In the second group (17 consecutive patients, Group 2), the same surgical repair was performed, but platelet-rich plasma was introduced into the lesion at the end of the procedure. Clinical outcomes were evaluated using KOOS and IKDC 2000 scores. MRI was performed at 1 year after surgery for objective evaluation.

Results

At a minimum of 24 months postoperatively (mean 32.2 months, 24–40), three patients underwent subsequent meniscectomy (two in Group 1, one in Group 2). The mean KOOS distribution (pain, symptoms, daily activities, sports, quality of life) was 78.4, 86.1, 93.8, 74.4, 74.6 in Group 1, and 93.3, 90.7, 97.1, 88.8, 78.3 in Group 2 (p < 0.05 for pain and sports parameters). MRI revealed five cases with the complete disappearance of any hypersignal within the repaired meniscus in Group 2, and none in Group 1 (p < 0.01).

Conclusions

Open meniscal repair of horizontal tears extending into the avascular zone was effective at midterm follow-up in young patients. Clinical outcomes were slightly improved by the addition of PRP in this case–control study.

Level of evidence

III.

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References

  1. Arnoczky SP, Sheibani-Rad S (2013) The basic science of platelet-rich plasma (PRP): what clinicians need to know. Sports Med Arthrosc 21:180–185

    Article  PubMed  Google Scholar 

  2. Arnoczky SP, Warren RF (1983) The microvasculature of the meniscus and its response to injury. An experimental study in the dog. Am J Sports Med 11:131–141

    Article  CAS  PubMed  Google Scholar 

  3. Arnoczky SP, Warren RF, Spivak JM (1988) Meniscal repair using an exogenous fibrin clot. An experimental study in dogs. J Bone Joint Surg Am 70:1209–1217

    CAS  PubMed  Google Scholar 

  4. Barwad P, Ramakrishnan S, Kothari SS, Saxena A, Gupta SK, Juneja R, Gulati GS, Jagia P, Sharma S (2013) Amplatzer vascular plugs in congenital cardiovascular malformations. Ann Pediatr Cardiol 6:132–140

    Article  PubMed Central  PubMed  Google Scholar 

  5. Becker R, Pufe T, Kulow S, Giessmann N, Neumann W, Mentlein R, Petersen W (2004) Expression of vascular endothelial growth factor during healing of the meniscus in a rabbit model. J Bone Joint Surg Br 86:1082–1087

    Article  CAS  PubMed  Google Scholar 

  6. Bhargava MM, Hidaka C, Hannafin JA, Doty S, Warren RF (2005) Effects of hepatocyte growth factor and platelet-derived growth factor on the repair of meniscal defects in vitro. In Vitro Cell Dev Biol Anim 41:305–310

    Article  CAS  PubMed  Google Scholar 

  7. Biedert RM (1993) Intrasubstance meniscal tears. Clinical aspects and the role of MRI. Arch Orthop Trauma Surg 112:142–147

    Article  CAS  PubMed  Google Scholar 

  8. Biedert RM (2000) Treatment of intrasubstance meniscal lesions: a randomized prospective study of four different methods. Knee Surg Sports Traumatol Arthrosc 8:104–108

    Article  CAS  PubMed  Google Scholar 

  9. Braun HJ, Wasterlain AS, Dragoo JL (2013) The use of PRP in ligament and meniscal healing. Sports Med Arthrosc 21:206–212

    Article  PubMed  Google Scholar 

  10. Cheung EV, Silverio L, Sperling JW (2010) Strategies in biologic augmentation of rotator cuff repair: a review. Clin Orthop Relat Res 468:1476–1484

    Article  PubMed Central  PubMed  Google Scholar 

  11. Crues JV 3rd, Mink J, Levy TL, Lotysch M, Stoller DW (1987) Meniscal tears of the knee: accuracy of MR imaging. Radiology 164:445–448

    Article  PubMed  Google Scholar 

  12. de Almeida AM, Demange MK, Sobrado MF, Rodrigues MB, Pedrinelli A, Hernandez AJ (2012) Patellar tendon healing with platelet-rich plasma: a prospective randomized controlled trial. Am J Sports Med 40:1282–1288

    Article  PubMed  Google Scholar 

  13. de Vos RJ, Weir A, van Schie HT, Bierma-Zeinstra SM, Verhaar JA, Weinans H, Tol JL (2010) Platelet-rich plasma injection for chronic Achilles tendinopathy: a randomized controlled trial. JAMA 303:144–149

    Article  PubMed  Google Scholar 

  14. Foster TE, Puskas BL, Mandelbaum BR, Gerhardt MB, Rodeo SA (2009) Platelet-rich plasma: from basic science to clinical applications. Am J Sports Med 37:2259–2272

    Article  PubMed  Google Scholar 

  15. Grant JA, Wilde J, Miller BS, Bedi A (2012) Comparison of inside-out and all-inside techniques for the repair of isolated meniscal tears: a systematic review. Am J Sports Med 40:459–468

    Article  PubMed  Google Scholar 

  16. Henning CE, Yearout KM, Vequist SW, Stallbaumer RJ, Decker KA (1991) Use of the fascia sheath coverage and exogenous fibrin clot in the treatment of complex meniscal tears. Am J Sports Med 19:626–631

    Article  CAS  PubMed  Google Scholar 

  17. Ionescu LC, Lee GC, Huang KL, Mauck RL (2012) Growth factor supplementation improves native and engineered meniscus repair in vitro. Acta Biomater 8:3687–3694

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  18. Ishida K, Kuroda R, Miwa M, Tabata Y, Hokugo A, Kawamoto T, Sasaki K, Doita M, Kurosaka M (2007) The regenerative effects of platelet-rich plasma on meniscal cells in vitro and its in vivo application with biodegradable gelatin hydrogel. Tissue Eng 13:1103–1112

    Article  CAS  PubMed  Google Scholar 

  19. Jarvinen TL, Sihvonen R, Malmivaara A (2014) Arthroscopic partial meniscectomy for degenerative meniscal tear. N Engl J Med 370:1260–1261

    CAS  PubMed  Google Scholar 

  20. Kamimura T, Kimura M (2011) Repair of horizontal meniscal cleavage tears with exogenous fibrin clots. Knee Surg Sports Traumatol Arthrosc 19:1154–1157

    Article  PubMed  Google Scholar 

  21. Kijowski R, Woods MA, McGuine TA, Wilson JJ, Graf BK, De Smet AA (2011) Arthroscopic partial meniscectomy: MR imaging for prediction of outcome in middle-aged and elderly patients. Radiology 259:203–212

    Article  PubMed  Google Scholar 

  22. Kobayashi K, Fujimoto E, Deie M, Sumen Y, Ikuta Y, Ochi M (2004) Regional differences in the healing potential of the meniscus-an organ culture model to eliminate the influence of microvasculature and the synovium. Knee 11:271–278

    Article  PubMed  Google Scholar 

  23. Krogh TP, Fredberg U, Stengaard-Pedersen K, Christensen R, Jensen P, Ellingsen T (2013) Treatment of lateral epicondylitis with platelet-rich plasma, glucocorticoid, or saline: a randomized, double-blind, placebo-controlled trial. Am J Sports Med 41:625–635

    Article  PubMed  Google Scholar 

  24. Kurzweil PR, Lynch NM, Coleman S, Kearney B (2014) Repair of horizontal meniscus tears: a systematic review. Arthroscopy. doi:10.1016/j.arthro.2014.05.038

  25. Lopez-Vidriero E, Goulding KA, Simon DA, Sanchez M, Johnson DH (2010) The use of platelet-rich plasma in arthroscopy and sports medicine: optimizing the healing environment. Arthroscopy 26:269–278

    Article  PubMed  Google Scholar 

  26. Lozano J, Ma CB, Cannon WD (2007) All-inside meniscus repair: a systematic review. Clin Orthop Relat Res 455:134–141

    Article  PubMed  Google Scholar 

  27. Moriguchi Y, Tateishi K, Ando W, Shimomura K, Yonetani Y, Tanaka Y, Kita K, Hart DA, Gobbi A, Shino K, Yoshikawa H, Nakamura N (2013) Repair of meniscal lesions using a scaffold-free tissue-engineered construct derived from allogenic synovial MSCs in a miniature swine model. Biomaterials 34:2185–2193

    Article  CAS  PubMed  Google Scholar 

  28. Muellner T, Egkher A, Nikolic A, Funovics M, Metz V (1999) Open meniscal repair: clinical and magnetic resonance imaging findings after twelve years. Am J Sports Med 27:16–20

    CAS  PubMed  Google Scholar 

  29. Nourissat G, Mainard D, Kelberine F, French Arthroscopic Society (SFA) (2013) Current concept for the use of PRP in arthroscopic surgery. Orthop Traumatol Surg Res 99(8 Suppl):S407–S410

    Article  CAS  PubMed  Google Scholar 

  30. Noyes FR, Barber-Westin SD (2002) Arthroscopic repair of meniscal tears extending into the avascular zone in patients younger than twenty years of age. Am J Sports Med 30:589–600

    PubMed  Google Scholar 

  31. Noyes FR, Barber-Westin SD (2012) Management of meniscus tears that extend into the avascular region. Clin Sports Med 31:65–90

    Article  PubMed  Google Scholar 

  32. Piontek T, Ciemniewska-Gorzela K, Szulc A, Slomczykowski M, Jakob R (2012) All-arthroscopic technique of biological meniscal tear therapy with collagen matrix. Pol Orthop Traumatol 77:39–45

    PubMed  Google Scholar 

  33. Pujol N, Bohu Y, Boisrenoult P, Macdes A, Beaufils P (2013) Clinical outcomes of open meniscal repair of horizontal meniscal tears in young patients. Knee Surg Sports Traumatol Arthrosc 21:1530–1533

    Article  PubMed  Google Scholar 

  34. Pujol N, Tardy N, Boisrenoult P, Beaufils P (2013) Magnetic resonance imaging is not suitable for interpretation of meniscal status ten years after arthroscopic repair. Int Orthop 37:2371–2376

    Article  PubMed Central  PubMed  Google Scholar 

  35. Rodkey WG (2000) Basic biology of the meniscus and response to injury. Instr Course Lect 49:189–193

    CAS  PubMed  Google Scholar 

  36. Rubman MH, Noyes FR, Barber-Westin SD (1998) Arthroscopic repair of meniscal tears that extend into the avascular zone. A review of 198 single and complex tears. Am J Sports Med 26:87–95

    CAS  PubMed  Google Scholar 

  37. Scotti C, Hirschmann MT, Antinolfi P, Martin I, Peretti GM (2013) Meniscus repair and regeneration: review on current methods and research potential. Eur Cell Mater 26:150–170

    CAS  PubMed  Google Scholar 

  38. Scotti C, Pozzi A, Mangiavini L, Vitari F, Boschetti F, Domeneghini C, Fraschini G, Peretti GM (2009) Healing of meniscal tissue by cellular fibrin glue: an in vivo study. Knee Surg Sports Traumatol Arthrosc 17:645–651

    Article  CAS  PubMed  Google Scholar 

  39. Sethi PM, Cooper A, Jokl P (2003) Technical tips in orthopaedics: meniscal repair with use of an in situ fibrin clot. Arthroscopy 19:E44

    Article  PubMed  Google Scholar 

  40. Sheth U, Simunovic N, Klein G, Fu F, Einhorn TA, Schemitsch E, Ayeni OR, Bhandari M (2012) Efficacy of autologous platelet-rich plasma use for orthopaedic indications: a meta-analysis. J Bone Joint Surg Am 94:298–307

    Article  PubMed  Google Scholar 

  41. Spindler KP, Mayes CE, Miller RR, Imro AK, Davidson JM (1995) Regional mitogenic response of the meniscus to platelet-derived growth factor (PDGF-AB). J Orthop Res 13:201–207

    Article  CAS  PubMed  Google Scholar 

  42. Suter LG, Fraenkel L, Losina E, Katz JN, Gomoll AH, Paltiel AD (2009) Medical decision making in patients with knee pain, meniscal tear, and osteoarthritis. Arthritis Rheum 61:1531–1538

    Article  PubMed Central  PubMed  Google Scholar 

  43. Taylor SA, Rodeo SA (2013) Augmentation techniques for isolated meniscal tears. Curr Rev Musculoskelet Med 6:95–101

    Article  PubMed Central  PubMed  Google Scholar 

  44. Tumia NS, Johnstone AJ (2004) Promoting the proliferative and synthetic activity of knee meniscal fibrochondrocytes using basic fibroblast growth factor in vitro. Am J Sports Med 32:915–920

    Article  PubMed  Google Scholar 

  45. Tumia NS, Johnstone AJ (2009) Platelet derived growth factor-AB enhances knee meniscal cell activity in vitro. Knee 16:73–76

    Article  PubMed  Google Scholar 

  46. Vance K, Meredick R, Schweitzer ME, Lubowitz JH (2009) Magnetic resonance imaging of the postoperative meniscus. Arthroscopy 25:522–530

    Article  PubMed  Google Scholar 

  47. Wei LC, Gao SG, Xu M, Jiang W, Tian J, Lei GH (2012) A novel hypothesis: the application of platelet-rich plasma can promote the clinical healing of white-white meniscal tears. Med Sci Monit 18:HY47–HY50

    PubMed Central  PubMed  Google Scholar 

  48. Zanetti M, Pfirrmann CW, Schmid MR, Romero J, Seifert B, Hodler J (2003) Patients with suspected meniscal tears: prevalence of abnormalities seen on MRI of 100 symptomatic and 100 contralateral asymptomatic knees. AJR Am J Roentgenol 181:635–641

    Article  PubMed  Google Scholar 

  49. Zellner J, Mueller M, Berner A, Dienstknecht T, Kujat R, Nerlich M, Hennemann B, Koller M, Prantl L, Angele M, Angele P (2010) Role of mesenchymal stem cells in tissue engineering of meniscus. J Biomed Mater Res A 94:1150–1161

    PubMed  Google Scholar 

  50. Zhang Z, Arnold JA (1996) Trephination and suturing of avascular meniscal tears: a clinical study of the trephination procedure. Arthroscopy 12:726–731

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Orthopedic Department, Centre Hospitalier de Versailles, Versailles-Saint Quentin University, 177, rue de Versailles, 78157, Le Chesnay, France

    Nicolas Pujol, Etienne Salle De Chou, Philippe Boisrenoult & Philippe Beaufils

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  1. Nicolas Pujol
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  2. Etienne Salle De Chou
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  3. Philippe Boisrenoult
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  4. Philippe Beaufils
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Correspondence to Nicolas Pujol.

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Pujol, N., Salle De Chou, E., Boisrenoult, P. et al. Platelet-rich plasma for open meniscal repair in young patients: Any benefit?. Knee Surg Sports Traumatol Arthrosc 23, 51–58 (2015). https://doi.org/10.1007/s00167-014-3417-3

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