There is a lot of research coming out that connects Platelet Rich Plasma therapy during or following the the surgical repair of a meniscus tear. At our office we try to achieve these goals of meniscus repair without the surgery. Let’s get to the research.
Here is a research study from August 2019 (1). In the introduction of the study, the research team introduced its readers to the understanding of how Platelet Rich Plasma injections can help people with meniscus tears.
“Platelet-rich plasma (PRP) is an autologous concentration of platelets that contain a large number of growth factors. These growth factors play a role in the regeneration, repair, and acceleration of the biochemical process, thereby reducing the pain associated with injuries of the articular cartilage and meniscus.”
Before I get to the study’s findings, here is a brief explanation of the growth factors in PRP and what they do:
PRP treatments involve collecting a small amount of your blood and spinning it in a centrifuge to separate your platelets from your red blood cells. The collected platelets are then injected back into the injured knee to stimulate healing and regeneration.
The platelets contain the following healing agents, or “growth factors.”
- Platelet-derived growth factor (PDGF) is a protein that helps control cell growth and division, especially blood vessels. When more blood (and the oxygen it carries) is delivered to the site of a wound, there is more healing.
- Transforming growth factor beta (or TGF-β) is important in tissue regeneration.
- Insulin-like growth factors are signaling agents. They help change the environment of the damaged joint from diseased to healing by “signaling” the immune system to start rebuilding tissue.
- Vascular endothelial growth factor (VEGF) is an important protein that brings healing oxygen to damaged tissue where blood circulation might be damaged or inadequate.
- Epidermal growth factor plays a key role in tissue repair mechanisms.
In the research study I mentioned above, the doctors evaluated the effectiveness of PRP injections in 126 patients with loss of cartilage and meniscus tears in their knees.
- Three treatments were given.
- The researchers concluded: “The results showed considerable improvement 3 months after the PRP application, and 6 months after the application the results remained approximately identical.” At 6 months the benefits were apparent.
Effectiveness of PRP in degenerative meniscal tears of the knee
A June 2022 paper (8) presented the results referring to the largest series of PRP-treated meniscal injuries sustained by a non-professional athletic population. In the present retrospective study, a positive effect for three PRP intraarticular and percutaneous injections (once a week) was found, with pain reduction, health status amelioration, and function improvement at a mean follow-up of 75.92 days. the researchers’ findings seem to confirm the clinical/functional benefit of PRP injections for meniscal lesions. The most important finding in this present study according to the research team was that the subjective scores of The Knee Injury and Osteoarthritis Outcome Score (KOOS), the Tegner activity scale of activity based on work and sports activities on a scale of 0 to 10, Feeling Thermometer, and Numeric Pain Rating Scale (0-10 scale) after PRP therapy achieved significant improvements with a patients’ satisfaction rate of 100% (very satisfied/satisfied) at a mean follow-up of 75.92 days. No complications or adverse effects were recorded in our series, highlighting PRP as a reliable and safe alternative to treat stable meniscal lesions and/or to postpone invasive surgical procedures.
A study from March 2020 (2) examined the effectiveness of PRP in degenerative meniscal tears of the knee. This study included 10 patients with meniscus tear but without knee osteoarthritis. This was a single treatment with follow up at 3 months and 6 months.
- Of the 6 patients who regularly participated in sports were able to recover competition or training.
- In seven patients who underwent MRI follow-up at 6 months, MRI showed stability of the meniscal tears
The doctors were able to conclude of this study: “Intra-meniscal administration of PRP under ultrasound guidance directly into meniscal degenerative lesions is feasible and safe.”
The demand for non-surgical options in people over 50 because the surgery may not work
Many of my new patients have come in for treatment because they want to continue walking the golf course, play tennis every other day, or, need to be on the worksite. When they get a surgical consult for a meniscus tear, they are told that arthroscopic partial meniscectomy for someone over 50 is controversial. This means that may not help or it may help for a short-term and this may lead them into a cascade of further surgeries. This was explained in a August 2019 study.(3)
In this study the hypothesis that people over 50, IF they had degenerative meniscus tears and knee osteoarthritis (a developing bone on bone situation) would benefit from an arthroscopic partial meniscectomy more so than a patient, over the age of 50, who only had a meniscus tear. Not so. According to the researchers there was no meaningful differences in patient satisfaction or clinical outcomes between patients with traumatic and degenerative tears and no or mild osteoarthritis. Also women, people who were obese, or people who had outer or lateral meniscus tears were less likely to be happy about their surgery.
PRP during meniscus surgery
At the beginning of this article I discussed that there were many papers coming out examining how PRP would help during a meniscus surgery. The strange thing is that a number of studies published during 2020 did not find PRP to be that helpful in accelerating the healing from the surgery.
A June 2020 study (4) suggested: “In early and limited investigations, there is insufficient evidence to support PRP augmentation of meniscal repair surgery improving functional and radiographic outcomes and resulting in lower failure rates compared with standard repair techniques.”
Another June 2020 study (5) made this suggestion: “There are a limited number of high-quality studies comparing outcomes and healing rates between patients undergoing meniscus repair versus without PRP augmentation. Based on the available evidence, patients undergoing meniscus repair with PRP augmentation experience similar clinical outcomes at midterm follow-up when compared with conventional meniscus repair , and additional studies are needed to determine the efficacy of MR augmented with PRP.”
Reducing surgical failure rate from 27% to 10%
The concept behind added PRP into the arthroscopic surgery procedure lies with the theory that PRP can reduce arthroscopic meniscus failure rates and accelerate healing post-surgery. A November 2020 study (6) followed patients who had PRP augmentation during arthroscopic surgery and those who did not. In this review analysis of previous published reports, the study authors analyzed five studies and 274 patients [110 with PRP and 164 without PRP].
The patients in these studies were 65.8% male; average age about 29.
- The risk of meniscal repair failure ranged from 4.4% to 26.7% for PRP-augmented repairs and 13.3% to 50.0% for repairs without PRP.
- Meniscal repairs augmented with PRP had significantly lower failure rates than repairs without PRP.
- Conclusion: Although the studies were of mostly of low quality, isolated arthroscopic meniscal repairs augmented with PRP led to significantly lower failure rates (10.8% vs 27.0%) as compared with repairs without PRP. However, most studies reported no significant differences in patient-reported outcomes.
Studies have suggested that PRP may not be effective during arthroscopic surgery because of the amount of fluids inserted into the knee during the arthroscopic procedure. The PRP may be “too watered down.”
PRP after meniscus surgery
Most of the time when someone contacts me about PRP after meniscus surgery it is usually about one of three things.
- The patients needs to play, tryout, participate in a sport and needs to get back quickly
- The patient needs to be functioning better at the worksite
- The surgery did not go that well
Can PRP accelerate healing after an arthroscopic meniscus repair? It depends on the type of surgery. If the meniscus was repaired with suture and little tissue was removed during the procedure, PRP will most probably be beneficial. If the arthroscopic surgery was a total meniscectomy, then we have to have a realistic expectation of what we are trying to do with the treatment. PRP will not regrow meniscus tissue if there is no meniscus left. PRP can help rebuild the remaining meniscus fragment to an extent. It can help repair it, but it cannot regenerate the “other half,” that was cut out.
PRP can be effective in helping stabilize and strengthening the other components of the knee to help accelerate healing after surgery. These would be the ligament and tendon attachments as well as the articular cartilage.
A study from September 2020 (7) looked at the benefits of PRP after a meniscus surgery. Here the suggestion was that while the clinical efficacy of platelet-rich plasma (PRP) as adjuvant therapy in patients undergoing arthroscopic repair of meniscal injury remains controversial. The findings of this meta-analysis suggest that PRP injection can effectively enhance the efficacy of arthroscopic repair of meniscal injury, reduce the failure rate and severity of pain, and improve active flexion.
Summary
Meniscus tears come in many sizes and types. Some meniscus tears will respond very well to PRP treatments, some will not. If you would like to understand more about how PRP treatments may help you with your meniscus tears, send me an email.
References
1 Mitev K, Longurov A. Intra-articular platelet-rich plasma injections for treating knee pain associated with articular cartilage and degenerative meniscal lesions. Open access Macedonian journal of medical sciences. 2019 Aug 15;7(15):2484.
2 Guenoun D, Magalon J, de Torquemada I, Vandeville C, Sabatier F, Champsaur P, Jacquet C, Ollivier M. Treatment of degenerative meniscal tear with intrameniscal injection of platelets rich plasma. Diagnostic and Interventional Imaging. 2020 Mar 1;101(3):169-76.
3 Lizaur-Utrilla A, Miralles-Muñoz FA, Gonzalez-Parreño S, Lopez-Prats FA. Outcomes and patient satisfaction with arthroscopic partial meniscectomy for degenerative and traumatic tears in middle-aged patients with no or mild osteoarthritis. The American journal of sports medicine. 2019 Aug;47(10):2412-9.
4 Haunschild ED, Huddleston HP, Chahla J, Gilat R, Cole BJ, Yanke AB. Platelet-rich plasma augmentation in meniscal repair surgery: a systematic review of comparative studies. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2020 Jun 1;36(6):1765-74.
5 Belk JW, Kraeutler MJ, Thon SG, Littlefield CP, Smith JH, McCarty EC. Augmentation of Meniscal Repair With Platelet-Rich Plasma: A Systematic Review of Comparative Studies. Orthopaedic Journal of Sports Medicine. 2020 Jun 17;8(6):2325967120926145.
6 Sochacki KR, Safran MR, Abrams GD, Donahue J, Chu C, Sherman SL. Platelet-Rich Plasma Augmentation for Isolated Arthroscopic Meniscal Repairs Leads to Significantly Lower Failure Rates: A Systematic Review of Comparative Studies. Orthopaedic Journal of Sports Medicine. 2020 Nov 20;8(11):2325967120964534.
7 Wang Y, Yao C, Yang Z, Guo W. Clinical efficacy of platelet-rich plasma as adjuvant therapy in patients undergoing arthroscopic repair of meniscal injury. Journal of International Medical Research. 2020 Sep;48(9):0300060520955059. –
8 Medina-Porqueres I, Martin-Garcia P, Sanz-De-Diego S, Gomez-Caceres A, Moya-Torrecilla F, Reyes-Eldblom M, Rosado-Velazquez D. Clinical and Functional Outcome of Meniscal Injuries Treated with Platelet-Rich Plasma: A Single-Center Case Series. International Journal of Environmental Research and Public Health. 2022 Jan;19(12):7118.