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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.
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.
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.
