AANA Lab Course 1002 -3rd Annual Fellows/Chief Residents-Biologic Augmentation of Meniscal Repair_ Options and Evidence-Jeremy M. Burnham, M.D.

Biologic Augmentation of Meniscal Repair_ Options and Evidence-Jeremy M. Burnham, M.D.

Pdf Summary

This presentation by Dr. Jeremy M. Burnham reviews biologic augmentation options and evidence for meniscus repair. The meniscus’s healing potential depends on vascularity, which declines from birth, leaving only the outer 10-30% vascular in adults—tears in this red-red zone have better healing prospects. Formation of a fibrin clot and techniques like abrading adjacent synovium aid healing. Meniscal repair outcomes improve with concomitant ACL reconstruction, which stabilizes the knee and introduces marrow elements.<br /><br />Prognosis depends on tear pattern and proximity to the menisco-capsular junction, with complex or double longitudinal tears having poorer healing. Chronic inflammatory changes are noted in synovial fluid after meniscal tears, underscoring the challenging healing environment.<br /><br />Biologic augmentation aims to promote healing in this relatively avascular tissue and disrupt degradation. Strategies include: <br />1) Mechanical stimulation (e.g., rasping) to increase neovascularization and growth factors; <br />2) Marrow venting, which mimics ACL tunnel drilling to release marrow elements, supported by animal studies and a level 1 RCT showing improved healing rates and function; <br />3) Fibrin clots, an inexpensive option using peripheral blood with limited but promising clinical evidence (up to 95% success in some studies); <br />4) Platelet-rich plasma (PRP), with mixed results from heterogeneous studies—overall, insufficient evidence supports its routine use; <br />5) Stem cell-based therapies, showing encouraging preclinical data and some early human studies indicating potential meniscal volume increase and repair quality improvements, though more research is required; and <br />6) Biomaterials like fascial sheaths or nanofibrous scaffolds, which show promise in covering complex tears and supporting healing but vary widely in approach and results.<br /><br />In sum, multiple biologic augmentation techniques exist to enhance meniscus repair, but the evidence varies, with marrow venting and fibrin clot showing some clinical support, stem cell and biomaterial approaches remaining investigational, and PRP lacking conclusive benefit at this time.

Keywords

meniscus repair

biologic augmentation

vascularity

fibrin clot

ACL reconstruction

tear pattern

marrow venting

platelet-rich plasma

stem cell therapy

biomaterials