Abstract
Meniscal tears are the most common orthopaedic injuries, with chronic lesions comprising up to 56% of cases. In these situations, no benefit with surgical treatment is observed. Thus, the purpose of this study was to investigate the effectiveness and safety of percutaneous intrameniscal platelet rich plasma (PRP) application to complement repair of a chronic meniscal lesion. This single centre, prospective, randomized, double-blind, placebo-controlled study included 72 patients. All subjects underwent meniscal trephination with or without concomitant PRP injection. Meniscal non-union observed in magnetic resonance arthrography or arthroscopy were considered as failures. Patient related outcome measures (PROMs) were assessed. The failure rate was significantly higher in the control group than in the PRP augmented group (70% vs. 48%, P = 0.04). Kaplan-Meyer analysis for arthroscopy-free survival showed significant reduction in the number of performed arthroscopies in the PRP augmented group. A notably higher percentage of patients treated with PRP achieved minimal clinically significant difference in visual analogue scale (VAS) and Knee injury and Osteoarthritis Outcome Score (KOOS) symptom scores. Our trial indicates that percutaneous meniscal trephination augmented with PRP results in a significant improvement in the rate of chronic meniscal tear healing and this procedure decreases the necessity for arthroscopy in the future (8% vs. 28%, P = 0.032).
Highlights
The menisci are known to play a pivotal role during normal functioning of the knee joint
Patients undergoing arthroscopy due to unacceptable quality of life were excluded from analysis of the Patient related outcome measures (PROMs)
All types of meniscectomies can lead to an increase in the risk of osteoarthritis [15] and evidence comparing the results of total and partial meniscectomy provide data on the beneficial effects of meniscus preservation [16]
Summary
The menisci are known to play a pivotal role during normal functioning of the knee joint Their unique and complex chondral structure, as well as their biology, make treatment and repair very challenging. 61% of those tears have no clinical symptoms of meniscal pathology (pain, aching, stiffness or oedema) [2]. These data provided the background for studies analysing the efficacy of arthroscopy in chronic meniscal lesion therapy. Several randomized clinical trials were performed and demonstrated no additional benefit of partial meniscectomy to sham surgery [3] These data introduced doubt into the current practice and resulted in making clinical decisions more challenging. These rationales shifted the treatment protocols of chronic meniscal tears into the non-operative manner and motivated the search for new therapeutic strategies
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