Biologic Adjuvants in Meniscus Repair: A Review of Current Translational and Clinical Evidence

Meniscus tears are common injuries in all age categories and cover a broad subset of lesions. Due to the lack of vascularization and blood clot formation, meniscus tears in the avascular zone possess poor healing potential. Preserving meniscus tissue however, is crucial to avoid early onset osteoarthritic changes in the knee joint. Meniscectomies are therefore, where possible, largely replaced by meniscus repair strategies. When tissue approximation (suturing) only is falling short for meniscal repair in the avascular zone, several types of biological augmentation can be recruited, which potentially benefits tear healing, and ultimately knee function. This review offers an overview of the current translational and clinical evidence regarding biologic augmentation methods for meniscus repair in a tear-type and location specific manner. Methods discussed include the use of mechanical stimulation with biological response ((para)meniscal rasping and trephination), bone marrow stimulation (± ACL reconstruction), external fibrin clot, platelet-rich plasma, cytokine/growth factor administration, and cell-based techniques.