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High survival rate after the combination of intrameniscal and intraarticular infiltrations of platelet-rich plasma as conservative treatment for meniscal lesions

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To evaluate the efficacy of applying a combination of intrameniscal and intraarticular infiltrations of Platelet-Rich Plasma (PRP) in patients with meniscal tears, analyzing its failure rate and clinical evolution, as well as factors that may influence the positive response to this treatment.

Methods

Three hundred and ninety-two cases out of 696 met the inclusion criteria and were included in this work. Survival and patient-reported outcome measure (PROM) were collected and analyzed. Survival rate was defined as the percentage of patients who did not undergo meniscus surgery during their follow-up time. Patients were asked to complete the Knee injury and Osteoarthritis Outcome Score (KOOS) at baseline, 6 months and 18 months. Other patient- and pathology-related variables were collected. Blood and PRP samples were randomly tested as a quality control measure. Survival and comparative statistical tests, and multivariate regression were performed for the analysis of the variables.

Results

The PRP applied had a platelet concentration factor of 1.9X in respect to blood levels, with no leukocytes or erythrocytes. Thirty-eight patients required surgical intervention after treatment reaching a survival rate of 90.3% with an estimated mean survival time of 54.4 months. The type of injury (P = 0.002) and the presence of chondropathy were risk factors for surgical intervention after PRP treatment (P = 0.043). All KOOS scores showed a significant statistical increase from baseline to 6 months (N = 93) and 18 months (N = 66) (P < 0.0001). The number of cases with minimal clinically important improvement (MCII) at 6 months and 18 months post-treatment was 65 (69.9%) and 43 (65.2%), respectively.

Conclusion

The combination of intrameniscal and intraarticular PRP infiltrations is a valid conservative treatment for meniscal injuries avoiding the need for surgical intervention. Its efficacy is higher in horizontal tears and decreases when joint degeneration is present.

Level of evidence

Level IV.

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Data Availability

The data presented in this study are available within the article and within the supplementary material. Additional inquiries may be directed to the corresponding author.

References

  1. Adams BG, Houston MN, Cameron KL (2021) The epidemiology of meniscus injury. Sports Med Arthrosc Rev 29(3):e24–e33

    Article  PubMed  Google Scholar 

  2. Alerskans S, Kostogiannis I, Neuman P (2022) Patient’s subjective knee function 3–5 years following partial meniscectomy or meniscus repair compared to a normal population: a retrospective cohort study. BMJ Open Sport Exerc Med 8(3):e001278

    Article  PubMed  PubMed Central  Google Scholar 

  3. Alessio-Mazzola M, Felli L, Trentini R, Formica M, Capello AG, Lovisolo S, Maffulli N (2022) Efficacy of autologous platelet-rich plasma injections for grade 3 symptomatic degenerative meniscal lesions: a 1-year follow-up prospective study. Sports Health 14(2):227–236

    Article  PubMed  Google Scholar 

  4. Beaufils P, Becker R, Kopf S, Englund M, Verdonk R, Ollivier M, Seil R (2017) Surgical Management of degenerative meniscus lesions: the 2016 ESSKA meniscus consensus. Joints 5(2):59–69

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Bedrin MD, Kartalias K, Yow BG, Dickens JF (2021) Degenerative joint disease after meniscectomy. Sports Med Arthrosc Rev 29(3):e44–e50

    Article  PubMed  Google Scholar 

  6. Betancourt JP, Murrell WD (2016) Leukocyte-poor platelet-rich plasma to treat degenerative meniscal tear: a case report. J Clin Orthop Trauma 7(Suppl 1):106–109

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Blough CL, Bobba CM, DiBartola AC, Everhart JS, Magnussen RA, Kaeding C, Flanigan DC (2021) Biologic augmentation during meniscal repair. J Knee Surg. https://doi.org/10.1055/s-0041-1739198

    Article  PubMed  Google Scholar 

  8. DePhillipo NN, LaPrade RF, Zaffagnini S, Mouton C, Seil R, Beaufils P (2021) The future of meniscus science: international expert consensus. J Exp Orthop 8(1):24

    Article  PubMed  PubMed Central  Google Scholar 

  9. Fernández-Matías R, García-Pérez F, Gavín-González C, Martínez-Martín J, Valencia-García H, Flórez-García MT (2023) Effectiveness of exercise versus arthroscopic partial meniscectomy plus exercise in the management of degenerative meniscal tears at 5-year follow-up: a systematic review and meta-analysis. Arch Orthop Trauma Surg 143(5):2609–2620

    Article  PubMed  Google Scholar 

  10. Green JS, Seddio AE, Roybal D, Moran J, Katz LD, Medvecky MJ (2022) Spontaneous healing of a posteriorly displaced lateral meniscus bucket-handle tear in a multiligament knee injury: a case report. JBJS Case Connect. https://doi.org/10.2106/JBJS.CC.22.00503

    Article  PubMed  Google Scholar 

  11. Guenoun D, Magalon J, de Torquemada I, Vandeville C, Sabatier F, Champsaur P, Jacquet C, Ollivier M (2020) Treatment of degenerative meniscal tear with intrameniscal injection of platelets rich plasma. Diagn Interv Imaging 101(3):169–176

    Article  CAS  PubMed  Google Scholar 

  12. Hagmeijer MH, Korpershoek JV, Crispim JF, Chen L-T, Jonkheijm P, Krych AJ, Saris DBF, Vonk LA (2021) The regenerative effect of different growth factors and platelet lysate on meniscus cells and mesenchymal stromal cells and proof of concept with a functionalized meniscus implant. J Tissue Eng Regen Med 15(7):648–659

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Kaminski R, Maksymowicz-Wleklik M, Kulinski K, Kozar-Kaminska K, Dabrowska-Thing A, Pomianowski S (2019) Short-term outcomes of percutaneous trephination with a platelet rich plasma intrameniscal injection for the repair of degenerative meniscal lesions. A prospective, randomized, double-blind, parallel-group, placebo-controlled study. Int J Mol Sci 20(4):E856. https://doi.org/10.3390/ijms20040856

    Article  CAS  Google Scholar 

  14. Keller RE, O’Donnell EA, Medina GIS, Linderman SE, Cheng TTW, Sabbag OD, Oh LS (2022) Biological augmentation of meniscal repair: a systematic review. Knee Surg Sports Traumatol Arthrosc 30(6):1915–1926

    Article  PubMed  Google Scholar 

  15. Kon E, Di Matteo B, Delgado D, Cole BJ, Dorotei A, Dragoo JL, Filardo G, Fortier LA, Giuffrida A, Jo CH, Magalon J, Malanga GA, Mishra A, Nakamura N, Rodeo SA, Sampson S, Sánchez M (2020) Platelet-rich plasma for the treatment of knee osteoarthritis: an expert opinion and proposal for a novel classification and coding system. Expert Opin Biol Ther. https://doi.org/10.1080/14712598.2020.1798925

    Article  PubMed  Google Scholar 

  16. Lucas G, Accadbled F, Violas P, Sales de Gauzy J, Knörr J (2015) Isolated meniscal injuries in paediatric patients: outcomes after arthroscopic repair. Orthop Traumatol Surg Res 101(2):173–177

    Article  CAS  PubMed  Google Scholar 

  17. Luvsannyam E, Jain MS, Leitao AR, Maikawa N, Leitao AE (2022) Meniscus tear: pathology, incidence, and management. Cureus 14(5):e25121. https://doi.org/10.7759/cureus.25121

    Article  PubMed  PubMed Central  Google Scholar 

  18. Maheshwer B, Wong SE, Polce EM, Paul K, Forsythe B, Bush-Joseph C, Bach BR, Yanke AB, Cole BJ, Verma NN, Chahla J (2021) Establishing the minimal clinically important difference and patient-acceptable symptomatic state after arthroscopic meniscal repair and associated variables for achievement. Arthroscopy 37(12):3479–3486

    Article  PubMed  Google Scholar 

  19. Makris EA, Hadidi P, Athanasiou KA (2011) The knee meniscus: structure-function, pathophysiology, current repair techniques, and prospects for regeneration. Biomaterials 32(30):7411–7431

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. McAllister DR, Motamedi AR (2001) Spontaneous healing of a bucket-handle lateral meniscal tear in an anterior cruciate ligament-deficient knee. A case report. Am J Sports Med 29(5):660–662

    Article  CAS  PubMed  Google Scholar 

  21. McDermott ID, Amis AA (2006) The consequences of meniscectomy. J Bone Joint Surg Br 88(12):1549–1556

    Article  CAS  PubMed  Google Scholar 

  22. Migliorini F, Cuozzo F, Cipollaro L, Oliva F, Hildebrand F, Maffulli N (2022) Platelet-rich plasma (PRP) augmentation does not result in more favourable outcomes in arthroscopic meniscal repair: a meta-analysis. J Orthop Traumatol 23(1):8

    Article  PubMed  PubMed Central  Google Scholar 

  23. Mitev K, Longurov A (2019) Intra-articular platelet-rich plasma injections for treating knee pain associated with articular cartilage and degenerative meniscal lesions. Open Access Maced J Med Sci 7(15):2484–2487

    Article  PubMed  PubMed Central  Google Scholar 

  24. Mordecai SC, Al-Hadithy N, Ware HE, Gupte CM (2014) Treatment of meniscal tears: an evidence based approach. World J Orthop 5(3):233–241

    Article  PubMed  PubMed Central  Google Scholar 

  25. Nepple JJ, Dunn WR, Wright RW (2012) Meniscal repair outcomes at greater than five years: a systematic literature review and meta-analysis. J Bone Joint Surg Am 94(24):2222–2227

    Article  PubMed  PubMed Central  Google Scholar 

  26. Neumann J, Kern K, Sun D, Foreman SC, Joseph GB, Gersing AS, Nevitt MC, McCulloch CE, Quitzke A, Link TM (2020) Cartilage degeneration post-meniscectomy performed for degenerative disease versus trauma: data from the osteoarthritis initiative. Skeletal Radiol 49(2):231–240

    Article  PubMed  Google Scholar 

  27. Nguyen JC, De Smet AA, Graf BK, Rosas HG (2014) MR imaging-based diagnosis and classification of meniscal tears. Radiographics 34(4):981–999

    Article  PubMed  Google Scholar 

  28. Noorduyn JCA, van de Graaf VA, Willigenburg NW, Scholten-Peeters GGM, Kret EJ, van Dijk RA, Buchbinder R, Hawker GA, Coppieters MW, Poolman RW, ESCAPE Research Group (2022) Effect of physical therapy vs arthroscopic partial meniscectomy in people with degenerative meniscal tears: five-year follow-up of the ESCAPE randomized clinical trial. JAMA Netw Open 5(7):e2220394

    Article  PubMed  PubMed Central  Google Scholar 

  29. Ozeki N, Koga H, Sekiya I (2022) Degenerative meniscus in knee osteoarthritis: from pathology to treatment. Life (Basel) 12(4):603. https://doi.org/10.3390/life12040603

    Article  PubMed  Google Scholar 

  30. Popescu MB, Carp M, Tevanov I, Nahoi CA, Stratila MA, Haram OM, Ulici A (2020) Isolated meniscus tears in adolescent patients treated with platelet-rich plasma intra-articular injections: 3-month clinical outcome. Biomed Res Int 2020:8282460

    Article  PubMed  PubMed Central  Google Scholar 

  31. Qi Y, Tang R, Shi Z, Feng G, Zhang W (2021) Wnt5a/Platelet-rich plasma synergistically inhibits IL-1β-induced inflammatory activity through NF-κB signaling pathway and prevents cartilage damage and promotes meniscus regeneration. J Tissue Eng Regen Med 15(7):612–624

    Article  CAS  PubMed  Google Scholar 

  32. Ronnblad E, Barenius B, Engstrom B, Eriksson K (2020) Predictive factors for failure of meniscal repair: a retrospective dual-center analysis of 918 consecutive cases. Orthop J Sports Med 8(3):2325967120905529

    Article  PubMed  PubMed Central  Google Scholar 

  33. Roos EM, Lohmander LS (2003) The knee injury and osteoarthritis outcome score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes 1:64

    Article  PubMed  PubMed Central  Google Scholar 

  34. Sánchez M, Beitia M, Pompei O, Jorquera C, Sánchez P, Knörr J, Soldado F, López L, Oraa J, Bilbao AM, Fiz N, Guadilla J, Aizpurua B, Azofra J, Delgado D (2019) Isolation, activation, and mechanism of action of platelet-rich plasma and its applications for joint repair. Regen Med IntechOpen. https://doi.org/10.5772/intechopen.90543

    Article  Google Scholar 

  35. Sánchez M, Delgado D, Pompei O, Pérez JC, Sánchez P, Garate A, Bilbao AM, Fiz N, Padilla S (2019) Treating severe knee osteoarthritis with combination of intra-osseous and intra-articular infiltrations of platelet-rich plasma: an observational study. Cartilage 10(2):245–253

    Article  PubMed  Google Scholar 

  36. Sánchez M, Delgado D, Sánchez P, Fiz N, Azofra J, Orive G, Anitua E, Padilla S (2014) Platelet rich plasma and knee surgery. Biomed Res Int 2014:890630

    Article  PubMed  PubMed Central  Google Scholar 

  37. Sánchez M, Jorquera C, de Dicastillo LL, Fiz N, Knörr J, Beitia M, Aizpurua B, Azofra J, Delgado D (2022) Real-world evidence to assess the effectiveness of platelet-rich plasma in the treatment of knee degenerative pathology: a prospective observational study. Ther Adv Musculoskelet Dis 14:1759720X221100304

    Article  PubMed  PubMed Central  Google Scholar 

  38. Sihvonen R, Paavola M, Malmivaara A, Itälä A, Joukainen A, Kalske J, Nurmi H, Kumm J, Sillanpää N, Kiekara T, Turkiewicz A, Toivonen P, Englund M, Taimela S, Järvinen TLN, FIDELITY (Finnish Degenerative Meniscus Lesion Study) Investigators (2020) Arthroscopic partial meniscectomy for a degenerative meniscus tear: a 5 year follow-up of the placebo-surgery controlled FIDELITY (Finnish Degenerative Meniscus Lesion Study) trial. Br J Sports Med 54(22):1332–1339

    Article  PubMed  Google Scholar 

  39. Urzen JM, Fullerton BD (2016) Nonsurgical resolution of a bucket handle meniscal tear: a case report. PM R 8(11):1115–1118

    Article  PubMed  Google Scholar 

  40. Wang Y, Yao C, Yang Z, Guo W (2020) Clinical efficacy of platelet-rich plasma as adjuvant therapy in patients undergoing arthroscopic repair of meniscal injury. J Int Med Res 48(9):300060520955059

    Article  PubMed  Google Scholar 

  41. Wesdorp MA, Eijgenraam SM, Meuffels DE, Bierma-Zeinstra SMA, Kleinrensink G-J, Bastiaansen-Jenniskens YM, Reijman M (2020) Traumatic meniscal tears are associated with meniscal degeneration. Am J Sports Med 48(10):2345–2352

    Article  PubMed  PubMed Central  Google Scholar 

  42. Wong C-C, Kuo T-F, Yang T-L, Tsuang Y-H, Lin M-F, Chang C-H, Lin Y-H, Chan WP (2017) Platelet-rich fibrin facilitates rabbit meniscal repair by promoting meniscocytes proliferation, migration, and extracellular matrix synthesis. Int J Mol Sci 18(8):E1722

    Article  Google Scholar 

  43. Yang C-P, Hung K-T, Weng C-J, Chen AC-Y, Hsu K-Y, Chan Y-S (2021) Clinical outcomes of meniscus repair with or without multiple intra-articular injections of platelet rich plasma after surgery. J Clin Med 10(12):2546. https://doi.org/10.3390/jcm10122546

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Zaffagnini S, Poggi A, Reale D, Andriolo L, Flanigan DC, Filardo G (2021) Biologic augmentation reduces the failure rate of meniscal repair: a systematic review and meta-analysis. Orthop J Sports Med 9(2):2325967120981627

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors wish to thank M.B. Sánchez, A. Iriondo, M. Montoya, M.J. Arnaiz and C. Pérez de Arrilucea for their involvement in the processing of the PRP samples.

Funding

This research received no external funding. The work in this article has recently won an award: “National Award for Research in Sports Medicine, Cajastur Foundation, year 2022. Faculty of Sports Medicine. University of Oviedo, Spain”.

Author information

Authors and Affiliations

  1. Arthroscopic Surgery Unit, Hospital Vithas Vitoria, Vitoria-Gasteiz, Spain

    Mikel Sánchez, Ane Miren Bilbao, Sergio González, Jaime Oraa & Jorge Guadilla

  2. Advanced Biological Therapy Unit, Hospital Vithas Vitoria, C/Beato Tomás de Zumárraga 10, 01008, Vitoria-Gasteiz, Spain

    Mikel Sánchez, Cristina Jorquera, Saínza García, Maider Beitia & Diego Delgado

  3. Clínica Espregueira—FIFA Medical Centre of Excellence, Porto, Portugal

    João Espregueira-Mendes

  4. Dom Henrique Research Centre, Porto, Portugal

    João Espregueira-Mendes

  5. School of Medicine, University of Minho, Braga, Portugal

    João Espregueira-Mendes

  6. ICVS/3B’s–PT Government Associate Laboratory, Braga/Guimarães, Portugal

    João Espregueira-Mendes

  7. 3B’s Research Group—Biomaterials, Biodegradables and Biomimetics, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, University of Minho, Barco, Guimarães, Portugal

    João Espregueira-Mendes

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  1. Mikel Sánchez
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Contributions

Each author has contributed substantially to the research, preparation and production of the paper and approves of its submission to the journal, according to ICMJE criteria: MS, CJ, MB, AMB and DD: contributed to the conception and design of the study. MS, AMB, SG, JG and JO: contributed to the provision of study materials and patients. CJ, SG, MB, JE-M and DD: contributed to analysis and interpretation of the data. MS, DD, SG, JE-M and MB: contributed to drafting, writing, critical revision and final approval of the article.

Corresponding author

Correspondence to Diego Delgado.

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The authors declare no conflict of interest.

Ethical approval

Ethical approval for this study was obtained from the Ethics Committee of the Basque Country (EPA2016067).

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Written informed consent was obtained from all subjects before the study.

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Supplementary Information

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Supplementary file1 Video 1. Ultrasound-guided intrameniscal PRP infiltration. Under ultrasound guidance, the medial meniscus is located in order to introduce the needle and infiltrate the meniscal wall. It is revealed as a triangle between the femoral condyle and the tibial plateau, delimited on the upper part by the medial collateral ligament. During infiltration, the PRP shows a hyperechoic signal. (M4V 8291 KB)

Supplementary file2 (DOCX 15 KB)

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Supplementary file8 (DOCX 17 KB)

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Sánchez, M., Jorquera, C., Bilbao, A.M. et al. High survival rate after the combination of intrameniscal and intraarticular infiltrations of platelet-rich plasma as conservative treatment for meniscal lesions. Knee Surg Sports Traumatol Arthrosc 31, 4246–4256 (2023). https://doi.org/10.1007/s00167-023-07470-4

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