LIMITED RECOMMENDATION The biological enhancement recommendation was downgraded for inconsistency of populations, as some studies only included discoid menisci patients.
One high level study (Kaminski, 2019) supports the use of bone marrow venting to improve outcomes of acute meniscal tears treated with surgical repair. The prospective randomized study showed definite benefits in terms of healing and patient reported outcomes with no change in complications, but it was a small cohort of vertical peripheral meniscal tears at a single study site. The use of PRP has been shown to improve outcomes of surgically repaired acute meniscal tears in one high (Liu, 2019) and three low level studies (Dai, 2019; Everhart, 2019; Pujol, 2015). One high level study showed a slight improvement in patient reported outcomes with the use of PRP, but it was a small cohort of acute tears of discoid menisci with very short-term follow. Another low-level study looking at the use of PRP to augment surgical repair of acute tears in discoid menisci showed no difference in clinical outcomes. One low level study was a retrospective review of a large single surgeon cohort which showed the use of PRP decreased the re-tear rate in the treatment of isolated acute meniscal tears but not tears repaired in conjunction with ACL reconstruction. Another low-level study showed slightly better clinical outcomes with the use of PRP in the repair of acute horizontal meniscus tears.
Benefits/Harms of Implementation
There is some evidence to suggest augmenting repairs of acute meniscal tears can improve healing and clinical outcomes. Bone marrow venting has little risk or cost. PRP has little risk but can have increased associated costs to the patient and health care system.
Outcome Importance
Improving the healing rate of meniscal repairs can improve symptoms and reduce rates of subsequent surgery in the short term and potentially reduce the rates of post-traumatic osteoarthritis in the long term.
Cost Effectiveness/Resource Utilization
Bone marrow venting has negligible cost whereas PRP often adds $500-$1000 or more to the cost of the procedure.
Acceptability
Bone marrow venting is very widely accessible as it can be performed by a variety of widely available surgical tools. PRP requires access to and paying for a system to prepare the sample.
Feasibility
Bone marrow venting is very feasible and should be considered in isolated surgical repair of acute meniscal tears. PRP can be considered depending on availability and cost considerations.
Future Research
Larger cohorts from multiple sites are needed to better understand the efficacy and generalizability of biological augmentation for surgical repair of acute meniscal tears. Studies to compare the efficacy and cost effectiveness of bone marrow venting and PRP would also be helpful.
- Dai, W. L., Zhang, H., Lin, Z. M., Shi, Z. J., Wang, J.. (2019). Efficacy of platelet-rich plasma in arthroscopic repair for discoid lateral meniscus tears. BMC Musculoskeletal Disorders, 20(1), 113.
- Everhart, J. S., Cavendish, P. A., Eikenberry, A., Magnussen, R. A., Kaeding, C. C., Flanigan, D. C.. (2019). Platelet-Rich Plasma Reduces Failure Risk for Isolated Meniscal Repairs but Provides No Benefit for Meniscal Repairs With Anterior Cruciate Ligament Reconstruction. American Journal of Sports Medicine, 47(8), 1789-1796.
- Kaminski, R., Kulinski, K., Kozar-Kaminska, K., Wasko, M. K., Langner, M., Pomianowski, S.. (2019). Repair Augmentation of Unstable, Complete Vertical Meniscal Tears With Bone Marrow Venting Procedure: A Prospective, Randomized, Double-Blind, Parallel-Group, Placebo-Controlled Study. Arthroscopy, 35(5), 1500-1508.e1.
- Liu, J.. (2019). Effect of arthroscopic surgery combined with platelet-rich plasma in the treatment of discoid meniscus injury of knee joint and its influence on serum inflammatory factors. European journal of inflammation, 17(0), . https://www.cochranelibrary.com/central/doi/10.1002/central/CN-02146659/full
- Pujol, N., Salle De Chou, E., Boisrenoult, P., Beaufils, P.. (2015). Platelet-rich plasma for open meniscal repair in young patients: any benefit?. Knee Surgery, Sports Traumatology, Arthroscopy, 23(1), 51-8.