Bone marrow stimulation improves 12‐month clinical outcomes after isolated meniscal repair: A double‐blind randomized controlled trial

Purpose To compare short‐term clinical outcomes and meniscal healing on magnetic resonance imaging (MRI) at 12 months between standard arthroscopic meniscal repair and repair augmented with bone marrow stimulation (BMS) in isolated meniscal tears. Methods In this prospective, two‐centre, double‐blind randomized controlled trial, patients aged 18–60 years with an isolated meniscal tear confirmed on MRI were randomized 1:1 to standard repair or repair augmented with BMS. Medial, lateral and bicompartmental tears were included. The primary outcome was the International Knee Documentation Committee (IKDC) subjective score at 12 months. Secondary outcomes were the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lysholm score, Tegner activity scale, pain on a visual analogue scale (VAS), patient satisfaction, operative time, adverse events and meniscal healing on 12‐month MRI (3.0‐T) (Crues classification, two‐blinded assessors). Results Fifty patients (mean age 40.2 years; 21 male and 29 female) were randomized; all completed follow‐up. Baseline characteristics were balanced; the augmented group received significantly more sutures (4.2 ± 1.4 vs. 3.3 ± 1.1; p = 0.011) and had fewer horizontal tears (44% vs. 76%; p = 0.042). At 6 months, Lysholm and satisfaction scores already favoured the augmented group. At 12 months, it was superior for the IKDC score (82.5 ± 12.6 vs. 56.5 ± 18.5), WOMAC score (14.6 ± 20.0 vs. 41.8 ± 32.5), Lysholm score (91.8 ± 6.4 vs. 72.6 ± 17.2), Tegner activity scale (median 5.0, interquartile range [IQR] 4.0–6.0 vs. 3.0, IQR 2.0–4.0), pain (0.6 ± 0.7 vs. 2.3 ± 2.3) and satisfaction (9.7 ± 0.6 vs. 7.9 ± 1.7); all p < 0.05. MRI healing did not differ between groups ( p = 0.783; unhealed: 2/25 [8%] per group); operative time was similar, and no complications occurred within 12 months. Conclusions In this cohort, BMS augmentation was associated with superior patient‐reported outcomes at 12 months, without additional complications or an increase in operative time. Meniscal healing on MRI did not differ between groups. These positive short‐term findings helped to prove the benefit of BMS augmentation, although confirmation in larger trials with longer follow‐up and structural assessment is required to clarify the effectiveness, durability and indications of BMS. Level of Evidence Level I, therapeutic randomized controlled trial.