Systematic reviews in PRP‐augmented meniscal repair have limited methodological quality: A systematic overview

Purpose: To evaluate the quality of the existing evidence on platelet-rich plasma (PRP) augmented meniscal repair using a validated appraisal tool, A MeaSurement Tool to Assess systematic Reviews (AMSTAR-2), and to offer guidance on how the findings of available systematic reviews should be interpreted. Study design: Systematic review. Methods: Five databases (PubMed, Web of Science, Embase, OvidMedline and Scopus) were searched from inception until August 2024 for systematic reviews analysing the role of PRP in meniscal repair. Methodological quality was assessed using Oxford Levels of Evidence and AMSTAR 2 grading. This review was conducted with adherence to PRISMA's guidelines for study selection and reporting. Results: Thirteen systematic reviews, published between 2020 and 2024, met inclusion criteria, analysing four to nine studies each. Nine performed meta-analyses, with study years ranging from 2014 to 2023. The methodological quality varied, with evidence levels ranging from I to IV. Four reviews conducted sensitivity analysis, four performed subgroup analysis, and one assessed publication bias. All reviews demonstrated critical methodological flaws according to AMSTAR-2, with 11 (84.6%) rated 'critically low' and two 'low' quality. There was substantial inconsistency in reporting complications and reoperation rates in systematic reviews. Conclusion: The quality of existing systematic reviews on PRP augmentation for meniscal repair is limited. As a result, there is insufficient evidence to conclude that PRP provides significant clinical or radiological benefit in meniscal repair. Therefore, we recommend cautious interpretation of the available evidence and stress on the need for high quality systematic reviews to pool the available evidence. Level of Evidence: Level II.