A narrative review on the translational and clinical application of platelet‐rich plasma, bone marrow concentrate and microfragmented adipose tissue for meniscal tears

Meniscal tears are a common knee pathology with an annual incidence of 66 per 100,000 patients and are associated with pain and an increased risk of osteoarthritis (OA). Orthobiological therapies have emerged as potential adjuncts to meniscal repair, but their clinical efficacy remains unclear. Minimally manipulated orthobiological therapies, including platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC) and microfragmented adipose tissue (MFAT), have primarily been investigated in OA therapies, with their use as adjuncts for meniscal tears subsequently investigated. This review evaluates the preclinical and clinical evidence for PRP, BMAC and MFAT in the treatment of meniscal tears. A literature search was performed to identify preclinical and clinical studies investigating PRP, BMAC and MFAT for meniscal tears. Methodology with respect to therapeutic approach and tear type was noted, whilst outcomes relating to meniscal healing and patient-reported clinical outcome measures were evaluated from the selected evidence. PRP was the most extensively studied approach amongst the orthobiologics reviewed, with heterogeneous findings in both preclinical and clinical studies. In general, PRP did not demonstrate significant differences in clinical outcome scores (Visual Analogue Scale, International Knee Documentation Committee, Knee Injury and Osteoarthritis Outcome Score or Lysholm) compared with suture-only controls in clinical studies, although one clinical study reported a lower re-rupture rate with PRP (14.6%) compared to suture-only (17%). Selected preclinical studies of BMAC indicated greater meniscal healing compared with PRP, although comparative clinical evidence remains limited. Clinical evidence for MFAT treatment of meniscal tears was restricted to case studies for degenerative meniscal tears in OA patients, with selected studies demonstrating improvements in patient-reported outcomes from baseline, although no preclinical animal studies using this approach were found. Heterogeneity in the application of these orthobiologics, tear type treated and surgical approach has led to inconsistent findings within the selected studies. Current evidence does not demonstrate consistent clinical superiority of PRP, BMAC or MFAT over standard meniscal treatments. PRP has the broadest but heterogeneous evidence base, whereas comparative clinical evidence for BMAC and MFAT remains limited. LEVEL OF EVIDENCE: N/A.