High survival rate after the combination of intrameniscal and intraarticular infiltrations of platelet-rich plasma as conservative treatment for meniscal lesions

Mikel Sánchez; Cristina Jorquera; Ane Miren Bilbao; Saínza García; Maider Beitia; João Espregueira-Mendes; Sergio González; Jaime Oraa; Jorge Guadilla; Diego Delgado

doi:10.1007/s00167-023-07470-4

High survival rate after the combination of intrameniscal and intraarticular infiltrations of platelet-rich plasma as conservative treatment for meniscal lesions

Knee Surg Sports Traumatol Arthrosc. 2023 Oct;31(10):4246-4256. doi: 10.1007/s00167-023-07470-4. Epub 2023 Jun 12.

Authors

Mikel Sánchez^{1

2}, Cristina Jorquera², Ane Miren Bilbao¹, Saínza García², Maider Beitia², João Espregueira-Mendes^{3

4

5

6

7}, Sergio González¹, Jaime Oraa¹, Jorge Guadilla¹, Diego Delgado⁸

Affiliations

¹ Arthroscopic Surgery Unit, Hospital Vithas Vitoria, Vitoria-Gasteiz, Spain.
² Advanced Biological Therapy Unit, Hospital Vithas Vitoria, C/Beato Tomás de Zumárraga 10, 01008, Vitoria-Gasteiz, Spain.
³ Clínica Espregueira-FIFA Medical Centre of Excellence, Porto, Portugal.
⁴ Dom Henrique Research Centre, Porto, Portugal.
⁵ School of Medicine, University of Minho, Braga, Portugal.
⁶ ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.
⁷ 3B's Research Group-Biomaterials, Biodegradables and Biomimetics, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, University of Minho, Barco, Guimarães, Portugal.
⁸ Advanced Biological Therapy Unit, Hospital Vithas Vitoria, C/Beato Tomás de Zumárraga 10, 01008, Vitoria-Gasteiz, Spain. diego.delgado@ucatrauma.com.

PMID: 37302993
DOI: 10.1007/s00167-023-07470-4

Abstract

Purpose: To evaluate the efficacy of applying a combination of intrameniscal and intraarticular infiltrations of Platelet-Rich Plasma (PRP) in patients with meniscal tears, analyzing its failure rate and clinical evolution, as well as factors that may influence the positive response to this treatment.

Methods: Three hundred and ninety-two cases out of 696 met the inclusion criteria and were included in this work. Survival and patient-reported outcome measure (PROM) were collected and analyzed. Survival rate was defined as the percentage of patients who did not undergo meniscus surgery during their follow-up time. Patients were asked to complete the Knee injury and Osteoarthritis Outcome Score (KOOS) at baseline, 6 months and 18 months. Other patient- and pathology-related variables were collected. Blood and PRP samples were randomly tested as a quality control measure. Survival and comparative statistical tests, and multivariate regression were performed for the analysis of the variables.

Results: The PRP applied had a platelet concentration factor of 1.9X in respect to blood levels, with no leukocytes or erythrocytes. Thirty-eight patients required surgical intervention after treatment reaching a survival rate of 90.3% with an estimated mean survival time of 54.4 months. The type of injury (P = 0.002) and the presence of chondropathy were risk factors for surgical intervention after PRP treatment (P = 0.043). All KOOS scores showed a significant statistical increase from baseline to 6 months (N = 93) and 18 months (N = 66) (P < 0.0001). The number of cases with minimal clinically important improvement (MCII) at 6 months and 18 months post-treatment was 65 (69.9%) and 43 (65.2%), respectively.

Conclusion: The combination of intrameniscal and intraarticular PRP infiltrations is a valid conservative treatment for meniscal injuries avoiding the need for surgical intervention. Its efficacy is higher in horizontal tears and decreases when joint degeneration is present.

Level of evidence: Level IV.

Keywords: Growth factors; Intraarticular; Intrameniscal; Meniscus; Platelet-rich plasma.

MeSH terms

Cartilage Diseases*
Conservative Treatment
Humans
Injections, Intra-Articular
Osteoarthritis*
Osteoarthritis, Knee* / pathology
Platelet-Rich Plasma*
Survival Rate
Treatment Outcome