Research on PRP injections for meniscus tears

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:

A March 2024 study (2) evaluated the latest evidence regarding the efficacy of PRP injections for the nonoperative management of degenerative meniscal pathology. In this study, researchers reviewed ten studies and 686 patient histories. Three different injection approaches were utilized, categorized as intra-articular alone , intra-meniscal alone, or a combination of both. Most studies demonstrated improved pain and functionality by 3 months that persisted for at least one year. Within the intra-articular and intra-meniscal groups, the majority of patients were either radiographically stable (30-70%) or demonstrated interval healing (40-60%). Several studies within intra-meniscal and combined treatment groups evaluated rates and time to arthroscopy, and found lower failure rates and greater arthroscopy-free survival time than control comparison groups.

Many patients have found success with PRP treatments during the meniscus procedure. An October 2022 study however outlines this: (3) “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 random control study evidence to support PRP augmentation of meniscus repair improving functional outcomes.”

PRP injections after meniscus surgery

I am going to return to the study (4) I mentioned above assessing if PRP injections would facilitate healing after a meniscus repair surgery. The authors of this research say:

“Vascularization and nutritional status of the injured meniscus area, as well as the type of meniscus tear, are important indicators for the success of meniscus reconstruction. The inner 2/3 of the meniscus (“white-white”) is nourished by diffusion of factors from the synovial fluid, while the peripheral “red-red zone” has a vascular supply. Between the white-white zone and the red-red zone is a red-white transition zone.

Due to its avascular nature, meniscal healing is a critical issue after injury. In the primary meniscal repair setting, some studies regarding isolated (meniscus) repair in ligament-stable knees observed variable clinical healing or success rates ranging between 33% and 76%. (This means the success was not achieved in 67% and 24% of patients in this range of studies). As many researchers suggest, concomitant ACL reconstruction surgery may improve the healing rates of a repaired meniscus compared to isolated repair. Research has focused on promoting healing with external stimulants, such as fibrin clots, fibrin glue, synovial grafts, periosteum and mesenchymal stem cells. PRP has been widely used in sports medicine with a variety of properties and applied methods.”

In this study, PRP injections were given to people after meniscus surgery and the results were compared to people who had meniscus surgery and no PRP injections. The researchers did not see any real difference. One reason the researchers speculated was PRP was not randomly assigned. The patients who received the PRP was decided on by the surgeon who may have had more extensive damage and who the researchers believed were not good candidates for PRP as “the healing potential in this group was lower.” They also noted on the positive that despite this, “the functional result and failure rate showed a trend that was better than that of the non-PRP group. “

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Platelet Rich Plasma Therapy for Meniscus Tears in Los Angeles

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 Li Z, Weng X. Platelet-rich plasma use in meniscus repair treatment: a systematic review and meta-analysis of clinical studies. Journal of Orthopaedic Surgery and Research. 2022 Dec;17(1):1-4.
3 Elphingstone JW, Alston ET, Colorado BS. Platelet-rich plasma for nonoperative management of degenerative meniscal tears: A systematic review. Journal of Orthopaedics. 2024 Mar 12.
4 Yang CP, Hung KT, Weng CJ, Chen AC, Hsu KY, Chan YS. Clinical Outcomes of Meniscus Repair with or without Multiple Intra-Articular Injections of Platelet Rich Plasma after Surgery. Journal of Clinical Medicine. 2021 Jan;10(12):2546.

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.