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Biological augmentation of meniscal repair: a systematic review

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

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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Authors and Affiliations

  1. Department of Orthopedic Surgery-Sports Medicine Service, Massachusetts General Hospital, 175 Cambridge St, Suite 400, Boston, MA, 02114, USA

    Rachel E. Keller, Evan A. O’Donnell, Giovanna I. S. Medina, Shannon E. Linderman, Timothy T. W. Cheng, Orlando D. Sabbag & Luke S. Oh

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  1. Rachel E. Keller
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  2. Evan A. O’Donnell
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Contributions

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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Correspondence to Rachel E. Keller.

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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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