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Meta-Analysis
. 2022 Oct 8;17(1):446.
doi: 10.1186/s13018-022-03293-0.

Platelet-rich plasma use in meniscus repair treatment: a systematic review and meta-analysis of clinical studies

Ziquan Li  1   2 , Xisheng Weng  3   4
Affiliations
Meta-Analysis

Platelet-rich plasma use in meniscus repair treatment: a systematic review and meta-analysis of clinical studies

Ziquan Li et al. J Orthop Surg Res. .

Abstract

Background: There is conflicting clinical evidence whether platelet-rich plasma (PRP) therapies could translate to an increased meniscus healing rate and improved functional outcomes. The objective of this systematic review and meta-analysis was to compare the failure rate and patient-reported functional outcomes in meniscus repair augmented with and without PRP.

Methods: We comprehensively searched the PubMed, Web of Science, Medline, Embase, and Cochrane Library databases to identify studies that compared the clinical efficacy of meniscus repair performed with PRP versus without PRP. The primary outcome was the meniscus repair failure rate, while the secondary outcomes were knee-specific patient-reported outcomes, including the International Knee Documentation Committee (IKDC) score, Lysholm knee scale, visual analog scale, Tegner activity level score, Western Ontario and McMaster Universities Osteoarthritis Index score, Single Assessment Numeric Evaluation score, and Knee injury and Osteoarthritis Outcome Score. Furthermore, subgroup analyses were performed by stratifying the studies according to the PRP preparation technique to investigate the potential sources of heterogeneity among studies.

Results: Our meta-analysis included nine studies (two RCTs and seven non-RCTs) with 1164 participants. The failure rate in the PRP group was significantly lower than that in the non-PRP group [odds ratio: 0.64, 95% confidence interval (CI) (0.42, 0.96), P = 0.03]. Furthermore, the PRP group was associated with a statistically significant improvement in the visual analog scale for pain [Mean difference (MD): - 0.76, 95% CI (- 1.32, - 0.21), P = 0.007] and Knee injury and Osteoarthritis Outcome Score-symptom [MD: 8.02, 95% CI (2.99, 13.05), P = 0.002] compared with the non-PRP group. However, neither the IKDC score nor the Lysholm knee scale showed any differences between the two groups. In addition, the results of subgroup analyses favored PRP over platelet-rich fibrin matrix (PRFM) regarding the IKDC score.

Conclusions: Although meniscus repairs augmented with PRP led to significantly lower failure rates and better postoperative pain control compared with those of the non-PRP group, there is insufficient RCT evidence to support PRP augmentation of meniscus repair improving functional outcomes. Moreover, PRP could be recommended in meniscus repair augmentation compared with PRFM. PRFM was shown to have no benefit in improving functional outcomes.

Keywords: Meniscus repair; Meta-analysis; Platelet-rich fibrin matrix; Platelet-rich plasma; Subgroup analysis; Systematic review.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of the meta-analysis
Fig. 2
Fig. 2
Comparisons of the failure rate between the PRP and control groups
Fig. 3
Fig. 3
Comparisons of patient-reported outcomes between the PRP and control groups
Fig. 4
Fig. 4
Comparisons of KOOS subscales between the PRP and control groups
Fig. 5
Fig. 5
Subgroup analysis of the association between the different forms of PRP applications
See this image and copyright information in PMC

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