Utilization of orthobiologic augmentation for meniscal repairs: current concepts and future perspectives

Meniscal tissue is a complex structure and performs a vital role in the normal biomechanical functioning of the knee joint. Unfortunately, meniscal tissue lacks vascularity and therefore demonstrates poor healing potential. To improve meniscal healing biological therapies have been used to enhance meniscal repairs and improve repair outcomes. Newer therapies incorporate growth factors and mesenchymal stem cells (MSCs) to improve the probability of healing and patient treatment outcomes under the term orthobiologics. To give a narrative review of orthobiologics utilized in meniscal repair therapies and determine their effectiveness and role in treating meniscal tears. A literature search was conducted using the PubMed (MEDLINE) and EMBASE databases in April 2021 without any date restrictions. Any relevant literature describing orthobiologic therapies utilized in meniscal repair was identified from the clinical databases and a narrative review was undertaken. Currently, orthobiologics used in clinical settings are autologous platelet-rich plasma (PRP) and MSC-based therapies. These demonstrate clinical benefit and enhanced meniscal repair. Standardizing PRP remains challenging and is essential to provide uniformity in treatment. Both therapies appear safe with no significant adverse effects, and MSC-based therapies do not show any increased risk of tumorgenicity. Orthobiologics in meniscal tears have shown mild to moderate clinical benefit, as demonstrated in a small series of clinical studies. However, literature on clinical results is scarce, and preclinical data remains the justification for these therapies. Larger, well-designed trials will determine their true benefit, and combining them with tissue engineering techniques may improve results in the future.