Abstract
Purpose
To review current randomized controlled trials (RCTs) investigating the efficacy of orthobiologic augmentation for anterior cruciate ligament reconstruction (ACLR) for clinical or radiographic outcomes.
Methods
PubMed, EMBASE, and the Web of Science databases were queried in accordance with the Preferred Reporting Items for Systematic reviews and Meta‐Analyses guidelines to identify RCTs investigating the efficacy of orthobiologics for ACLR. Studies were included if they compared patient‐reported outcome measures or radiographic evaluation of graft maturation of ACLR with and without orthobiologics. Included forms of orthobiologics were platelet‐rich plasma, bone marrow aspirate concentrate, and mesenchymal stem cell. Studies were excluded if they applied the orthobiologic to the harvest or donor site, rather than the ACL graft itself, or if they did not report patient‐reported outcome measures or radiographic evaluation of graft maturation. For outcome measures with 3 or more studies that used the same orthobiologic, meta‐analyses were conducted using DerSimonian‐Laird random‐effects models, reported in standardized mean difference (SMD).
Results
There were 9 RCTs with 543 total patients investigating platelet‐rich plasma (5 studies), bone marrow aspirate concentrate (3 studies), and mesenchymal stem cell (1 study) augmentation in ACLR. Meta‐analysis revealed no significant difference in Lysholm scores (SMD = 0.99 [0.72‐1.36],
I
2
= 0.58%,
P
= .95) with versus without platelet‐rich plasma augmentation for ACLR. Similar knee injury and osteoarthritis outcome scores were found for ACLR augmented by bone marrow aspirate concentrate versus ACLR alone (SMD = 0.78 [0.41‐1.49],
I
2
= 76.97%,
P
= .45). Orthobiologic augmentation was not found to decrease bone tunnel enlargement (SMD = 1.56 [0.61‐3.96],
I
2
= 87.46%,
P
= .35). All studies reported a radiographic evaluation of graft maturation, 6 of which reported no significant change with orthobiologic augmentation. No complications related to orthobiologics were reported.
Conclusions
Orthobiologic augmentation for ACLR shows similar patient‐reported outcome measures and bone tunnel healing as compared with ACLR alone, although these results are limited by heterogeneity. This review suggests limited efficacy regarding orthobiologic augmentation for ACLR.
Level of Evidence
Level II, systematic review and meta‐analysis of Level I and II randomized controlled trials.