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Biologic augmentation strategies in meniscus repair: A Delphi study.

Jonathan T Super1, Iain R Murray1, Luke V Tollefson2

  • 1Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK.

Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA
|February 19, 2026
PubMed
Summary

Experts recommend low-cost biological augmentation for high-risk meniscus tears, cautioning against routine platelet-rich plasma (PRP) and cell therapies. Standardized reporting and trials are key for improving meniscus repair outcomes.

Keywords:
arthroscopybiologicskneemeniscal repairmeniscus

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Area of Science:

  • Orthopedic Surgery
  • Regenerative Medicine
  • Biomaterials

Background:

  • Meniscus repair aims to restore function and prevent osteoarthritis.
  • Biological augmentation techniques modify the local healing environment to improve repair success.
  • Consensus on indications and best practices for these techniques is lacking.

Purpose of the Study:

  • Establish international expert consensus on biological augmentation for meniscus repair.
  • Define indications, terminology, decision-making, and outcome assessment.
  • Identify research priorities for biological augmentation strategies.

Main Methods:

  • Delphi study methodology adhering to current guidance.
  • Scoping review to inform statement generation.
  • International multidisciplinary expert panel (33 members) participated in three anonymized survey rounds.

Main Results:

  • Consensus reached on 66/67 statements (98.5% agreement).
  • Biologic augmentation defined as modifying the healing environment, not regeneration.
  • Recommended selective use of simple, low-cost strategies (trephination, marrow venting, fibrin clot) for high-risk tears (radial, complex, horizontal).
  • Evidence inconclusive for routine use of autologous blood products (e.g., platelet-rich plasma [PRP]) and cell-based therapies.
  • Routine postoperative MRI for asymptomatic individuals not recommended; interpretation should include clinical findings.
  • Ethical concerns raised for higher-cost cell therapies (marketing, claims, reporting).

Conclusions:

  • Pragmatic, tear-specific recommendations for biological augmentation in meniscus repair.
  • Prioritizes low-cost strategies for higher-risk tears.
  • Cautions against routine use of PRP and cell-based therapies without robust evidence.
  • Highlights need for standardized terminology, outcome reporting, and comparative trials.