Summary

This study is a methodologically rigorous scoping review to map out the current literature regarding the use of biologic augmentation strategies for arthroscopic meniscal repair, summarising available evidence and identifying existing gaps in the literature to determine future research priorities.

Abstract

Aim

The aim of this study was to carry out a scoping review to investigate the use of biologic augmentation strategies for arthroscopic meniscal repair.

Methods

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews and Arksey and O’Malley frameworks were followed. Relevant studies as well as grey literature were obtained using a three-step search strategy. The studies were screened with criteria for inclusion comprising clinical trials evaluating the biologic augmentation of arthroscopic meniscal repair, systematic reviews, opinion pieces, consensus statements and conference proceedings. Data was extracted and presented as a descriptive analysis and thematic summary.

Results

A total of 1,135 studies were initially identified, with 125 meeting the inclusion criteria. 52.8 % (66) of these studies were published in the last five years, and 50.4% (63) originated from the United States of America. Most of the evidence was either level IV or V (87 articles, 69.6%). Systematic reviews and meta-analyses made up 11.2 % (14) of the studies. The most frequently studied biological augmentation technique was the use of platelet-rich plasma (PRP; 58 articles, 46.4 %), followed by fibrin clots and mesenchymal stromal cells respectively. There were two randomised control trials included, both showing a significant reduction in vertical meniscal repair failure with biological augmentation against repair alone. In one, the rate of healing was higher with PRP augmentation (p = 0.048) on second look arthroscopy or magnetic resonance imaging compared with placebo at eighteen weeks (n = 37). The other showed the same result with bone marrow venting (p = 0.0035) on second look arthroscopy at thirty-six weeks (n = 40). Ninety-four of the included studies (75.2 %) discussed biological augmentation in the context of a mix of different meniscal tear morphologies, rather than specific tear types. The clinical studies included were methodologically diverse, highlighting the absence of consensus concerning the use of biologics to augment meniscal repair. Across these studies, there were twenty-eight different outcome measures used to determine the success of biological augmentation of meniscal repair. The duration of post-operative follow-up ranged from three to sixty months, again highlighting the absence of protocol amongst included studies.

Conclusion

There is diverse use of biologic therapies for the augmentation of meniscal repairs, and this scoping review is the first to provide a methodologically rigorous search mapping out the available literature. There is currently a paucity of high-quality evidence to define indications and usage. Further research priorities include defining which meniscal tear types and locations might benefit from specific biologic augmentation techniques, as well as outcome measures and diagnostic modalities to detect the success of these interventions. This review highlights the urgent need for consensus among experts on the appropriate use of biologic application, until high quality level I studies are available to guide clinicians.