Biologic Augmentation for Meniscus Repair: A Narrative Review

Area of Science:

• Orthopedic Surgery
• Regenerative Medicine
• Biomedical Engineering

Background:

• Meniscal preservation is crucial for long-term knee health, but healing is limited by poor vascularity and cellularity.
• Factors like dense extracellular matrix, biomechanical stress, and inflammation impede meniscus repair, especially in avascular regions.

Purpose of the Study:

• To review the biological basis of meniscus healing.
• To critically evaluate current and emerging biologic augmentation strategies for meniscus repair.
• To integrate these strategies within a framework targeting vascular, cellular, matrix, biomechanical, and immunologic factors.

Main Methods:

• Literature review of biologic augmentation techniques for meniscus repair.
• Analysis of strategies including synovial abrasion, fibrin clot, marrow stimulation, platelet-derived biologics, cell therapies, and scaffolds.
• Integration of findings into a unified therapeutic framework.

Main Results:

• Various biologic augmentation strategies have been explored to enhance meniscus healing.
• These methods aim to overcome the intrinsic limitations of meniscal repair.
• A framework is proposed to guide future research by targeting key biological factors.

Conclusions:

• Understanding and modulating cellular and molecular mechanisms are key to improving meniscus healing.
• Developing mechanism-driven strategies can enhance repair outcomes.
• Effective meniscus repair strategies may reduce the risk of post-traumatic osteoarthritis.