Purpose: To investigate the efficacy of platelet‐rich plasma (PRP) as an augmentation in meniscus repair. Methods: A comprehensive search of PubMed, Medline (via EBSCO), ProQuest, and ScienceDirect from January to February 2023 was conducted using the terms “meniscus repair,” “PRP,” and “meniscus tear.” Meta‐analyses that investigated the rate of failure after meniscus repair were included. Studies before 2003, not in English, associated procedures during surgery, and animal studies were excluded. The included studies underwent quality appraisal and risk of bias assessment. Data were extracted from each study‘s text, figures, tables, and associated supplementary files and then analyzed qualitatively. Results: The failure rate is lower in the PRP augmentation group compared with the group without augmentation, with a mean difference of 0.42, 0.50, and 0.43. Visual analog scale score was also found to be significantly lower in the treatment group, with a mean difference of 0.40, 0.76, and 6.69. However, only mean differences in Lysholm score in one of the included studies were found significant regarding functional outcomes, which can be found in the Xie et al. study with a mean difference of 3.06. Conclusions: In this study, we found that meniscal repairs augmented with PRP have a lower failure rate. Level of Evidence: Level IV, systematic review of Level III‐IV studies.

Objetivo A tenodese extra-articular lateral (TEL) foi proposta para resolver a instabilidade rotatória após a reconstrução do ligamento cruzado anterior (RLCA). Esta metanálise teve como objetivo comparar os resultados clínicos da RLCA e da RLCA com TEL por meio da técnica de Lemaire modificada. Materiais e Métodos Esta metanálise foi feita de acordo com a declaração dos Itens Principais para Relatar Revisões Sistemáticas e Metanálises (Preferred Reporting Items for Systematic Reviews and Meta-Analysis, PRISMA, em inglês). A pesquisa bibliográfica foi realizada nos bancos de dados PubMed, EBSCOHost, Scopus, ScienceDirect e WileyOnline. Dos estudos incluídos foram extraídas informações sobre as características do estudo, a taxa de falha (falha clínica ou do enxerto) como resultado primário, e o escore funcional como resultado secundário. Foram feitas comparações entre os pacientes submetidos apenas à RLCA (grupo RLCA) e à RLCA e TEL pela técnica de Lemaire modificada (grupo RLCA + TEL). Resultados Foram avaliados 5 estudos que incluíam 797 pacientes. O grupo RLCA + TEL apresentou um risco menor de falha e menor taxa de rerruptura do que o grupo RLCA (razão de risco [RR] = 0,44; intervalo de confiança de 95% [IC95%] 0,26 a 0,75; I² = 9%; p = 0,003). O grupo RLCA + TEL obteve pontuações maiores no Escore de Desfechos de Osteoartrite e Lesão no Joelho (Knee Injury and Osteoarthritis Outcome Score, KOOS, em inglês) com relação aos seguintes desfechos: dor, atividades cotidianas (AC), esportes, e qualidade de vida (QV), com diferenças médias de 0,20 (IC95%: 0,10 a 0,30; I² = 0%; p < 0,0001), -0.20 (IC95%: -0,26 a-0,13; I² =0%; p < 0,00001), 0,20 (IC95%: 0,02 a 0,38; I² = 0%; p = 0,03) e 0,50 (IC95%: 0,29 a 0,71; I² = 0%; p < 0,00001), respectivamente, quando comparado com o grupo RLCA. Conclusão O acréscimo de TEL pela técnica de Lemaire modificada à RLCA pode melhorar a estabilidade do joelho devido à menor taxa de rerruptura do enxerto e à superioridade dos resultados clínicos. Nível de evidência I. Trabalho desenvolvido no Departmento de Cirurgia Ortopédica, St. Carolus Hospital, Faculty of Medicine, Trisakti University, Jacarta, Indonésia. Received: 27 March 2023 Accepted: 25 August 2023 Article published online: 10 April 2024 © 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/) Thieme Revinter Publicações Ltda. Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

Background: Meniscus injuries are familiar sources of knee pain, with meniscus repair sometimes yielding unsatisfactory results. Microfracture is a standard procedure for treating articular cartilage damage in the knee that promotes the formation of fibrocartilage over damaged cartilage. Microfracture enhanced the healing rate of meniscus repair in animal models. Objective: Investigate the effectiveness of microfracture augmentation on the wall of femoral condyle in meniscus healing among patients with meniscus repair. Methods: The current study, conducted in a single center, involved patients with red-white zone meniscal tears due to sports injury who underwent arthroscopic meniscus repair between January 2018 and December 2023. Meniscal repair was performed without microfracture in the control group but with microfracture augmentation in the intervention group. Results: Functional outcomes, assessed using the Lysholm score, were significantly better in the microfracture group ( p = 0.000). Both groups showed significant reductions in tear size according to its intensity on magnetic resonance imaging (MRI) ( p = 0.002 in the control group and p = 0.001 in the microfracture group), with a notably better meniscus healing rate (35.7%) in the microfracture group compared to the control group. Conclusion: This initial study highlights substantial effectiveness between meniscus repair augmented with microfracture and enhanced healing compared to repair without microfracture. Functional scores were notably higher, and MRI signal intensity decreased to grade 1 in a significant portion of patients in the microfracture group.

Background: The medial collateral ligament (MCL) is one of the most commonly injured ligaments in the knee, accounting for 40% of all knee injuries. Autologous platelet concentrate, such as platelet-rich plasma (PRP) and platelet-rich fibrin (PRF), has been proposed as a novel therapy in ligament injury. Purpose: To evaluate the effectiveness of PRP and PRF in recovery after MCL injury. Study Design: Controlled laboratory study. Methods: This study was a randomized, single-blind, in vivo study on MCL injury in Wistar rats ( Rattus norvegicus ). Rats that were sick, had a decrease in body weight of >10% after adaptation in the laboratory, or died were excluded. A total of 30 male Wistar rats were divided into 3 groups: group 1 (n=10) received no intervention, group 2 (n=7) received PRP, and group 3 (n=10) received PRF. The variables that were investigated included tensile strength and histopathological appearance. All statistical analysis was performed using SPSS 22.0 using the appropriate test based on the variable. Results: This study found that there was a significant difference in tensile strength across all groups ( P = .004), with a significantly higher value in the PRF group compared with the PRP group (mean difference, 2.76; P = .003). There was no significant correlation between tensile strength and ligament length ( P = .34). Based on the histopathological data, this study found that PRF resulted in a higher amount of collagen cell orientation when compared with PRP and control ( P = .049). Conclusion: This study found that PRF was associated with greater tensile strength when compared with PRP and control. However, more studies with a longer observation period and further trials, especially in humans, should be conducted to confirm this finding. Clinical Relevance: PRF injection can be a novel therapy consideration for ligament injury, with a better result in both function and histological appearance when compared with PRP.

Background: Anterior cruciate ligament (ACL) injury is one of the most prevalent factors contributing to knee instability worldwide. This study aimed to evaluate modified metal fixation techniques for ACL reconstruction compared to factory-made implants, such as polyether ether ketone (PEEK) screws, bioabsorbable screws, and modified metal implants. Methods: A retrospective cohort analysis was conducted to assess the functional outcomes of ACL using various fixation methods. Patients who underwent arthroscopic ACL reconstruction at several healthcare facilities were included in the study. The functional outcomes were evaluated using the Lysholm Knee Scoring Scale and the International Knee Documentation Committee (IKDC) score questionnaire at 6- and 12 months post-surgery. Statistical analyses, including the Shapiro–Wilk test and analysis of variance, were performed to compare outcomes among the fixation groups. Results: Thirty-three patients who underwent ACL reconstruction surgery with varying distributions across the three fixation groups (modified metal implants, PEEK screws, and bioabsorbable screws) were included in the study. As measured by the Lysholm and IKDC scores at 6- and 12 months post-surgery, the PEEK group demonstrated the highest average scores. Nevertheless, these functional outcomes were not significantly different between the groups (p = 0.140, 0.770, 0.150, and 0.200). These findings align with those of meta-analyses comparing different fixation methods for ACL reconstruction. Conclusions: While acknowledging the small sample size as a limitation, this study suggests that modified metal implants represent viable options for ACL reconstruction. The selection of fixation methods should consider patient characteristics and preferences, emphasizing biomechanical stability and long-term outcomes. Further research is needed to validate these findings and explore their biomechanical properties and cost-effectiveness.

Article: Comparison in outcome after removal of implant in anterior cruciate ligament reconstruction using modified implant - Chirurgia 2024 October;37(5):355-9 - Minerva Medica - Journals