Platelet-Rich Plasma and Marrow Venting May Serve as Cost-Effective Augmentation Techniques for Isolated Meniscal Repair: A Decision-Analytical Markov Model-Based Analysis

Current practice of biologic augmentation techniques to enhance the healing of meniscal repairs: A collaborative survey within the Meniscus International Network (MenIN) Study Group

PURPOSE

To evaluate practices and preferences among expert sports knee surgeons regarding biologic augmentation techniques in meniscal repair.

METHODS

A 12-question multiple-choice survey was distributed to the Meniscus International Network (MenIN) Study Group. It covered biologic augmentation techniques for various meniscal tear types, both in isolation and with anterior cruciate ligament reconstruction (ACLR). Eight options were assessed: no augmentation, trephination, rasping, marrow venting, fibrin clot, platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC) and meniscal wrapping. Surgeons could select multiple techniques per scenario.

RESULTS

Forty-two surgeons participated: 42% from Europe, 18% from North America, 10% from Latin America, 21% from Asia and 9% from Africa/Oceania. For isolated meniscal tears (excluding meniscal root tears), 90% of surgeons used at least one biologic augmentation technique. For meniscal tears associated with ACLR, 66% of surgeons used at least one biologic augmentation technique. The most utilized techniques were rasping (19%-69%), trephination (7%-43%), and marrow venting (0%-74%). PRP (2%-19%), BMAC (0%-14%) and meniscal wrapping (0%-10%) were least used. Biologic augmentation was most frequent for isolated radial (93%), isolated bucket-handle (86%), isolated vertical (86%) and isolated horizontal tears (98% for younger patients, 86% for degenerative tears). ACLR-associated repairs had lower augmentation rates, and meniscal root tears showed the highest percentage of non-augmented repairs. Over 50% of surgeons use a single augmentation technique, while 20% use two techniques depending on tear type. Overall, 33.3% (n = 14) of surgeons reported utilizing PRP and/or BMAC for meniscal repair augmentation, with the highest use observed in South America (12%) based on geographic usage.

CONCLUSIONS

This survey provides insights into current meniscal repair practices among expert orthopaedic sports medicine surgeons. The findings reveal variability in approaches based on tear patterns and associated procedures, with a general preference for simpler mechanical augmentation techniques over more advanced biologics. For isolated meniscal tears (excluding meniscal root tears), 90% of surgeons in this cohort report using one or more biological augmentation techniques.

LEVEL OF EVIDENCE

Level V expert opinion.

Biologic Augmentation of Isolated Meniscal Repair

PURPOSE OF REVIEW

The limited blood supply and intrinsic healing capacity of the meniscus contributes to suboptimal tissue regeneration following injury and surgical repair. Biologic augmentation techniques have been utilized in combination with isolated meniscal repair to improve tissue regeneration. Several innovative strategies such as Platelet-Rich Plasma (PRP), fibrin clots, mesenchymal stem cells (MSCs), bone marrow stimulation, meniscal scaffolds, and meniscal wrapping, are being explored to enhance repair outcomes. This article provides a comprehensive review of recent findings and conclusions regarding biologic augmentation techniques.

RECENT FINDINGS

Studies on PRP reveal mixed outcomes, with some suggesting benefits in reducing failure rates of isolated meniscal repair, while others question its efficacy. Fibrin clots and PRF (Platelet-rich fibrin), although promising, show inconsistent results and lack sufficient evidence for definitive conclusions. MSCs demonstrate potential in preclinical studies, but clinical trials have been limited and inconclusive. Bone marrow stimulation appears effective in certain contexts, but its broader applicability remains uncertain. Meniscal scaffolds, including CMI (Collagen Meniscal Implants) and Actifit (polyurethane scaffolds), show encouraging short- and mid-term outcomes but have not consistently surpassed traditional methods in the long term. Meniscal wrapping is infrequently studied but demonstrates positive short-term results with certain applications. The review reveals a diverse range of outcomes for biologic augmentation in meniscal repair. While certain techniques show promise, particularly in specific scenarios, the overall efficacy of these methods has yet to reach a consensus. The review underscores the necessity for standardized, high-quality research to establish the definitive effectiveness of these biologic augmentation methods.

Editorial Commentary: Biologic Stimulation Using Marrow Venting for Meniscus Repair is Cost Effective and Recommended

Current literature offers little guidance on the most cost-effective approach to intraoperative biologic stimulation in the setting of arthroscopic meniscus repair. Combining data from robust systematic reviews into a Markov Decision Making Model reveal the ideal strategy: Strong consideration should be given to biologic stimulation for all meniscal repairs, and the most cost effective technique is marrow stimulation.