Can we treat meniscal tears with injectables? A systematic review of clinical outcomes following platelet-rich plasma, corticosteroid, and other injective therapies for degenerative and traumatic meniscal lesions

Background: Meniscal tears, whether degenerative or traumatic, are common causes of knee pain. Concerns regarding long-term joint degeneration after arthroscopic partial meniscectomy have increased interest in joint-preserving injective therapies. Objectives: To systematically review clinical outcomes, imaging findings, and surgical conversion rates following standalone injective treatments for meniscal pathology. Data sources: A systematic search of PubMed, Embase, and Cochrane Library was performed on August 29, 2025. Study eligibility criteria, participants, and interventions: English-language clinical studies (2010–2025) evaluating standalone injective therapies for meniscal tears or degeneration were included. Interventions comprised platelet-rich plasma (PRP), corticosteroids, hyaluronic acid (HA), polynucleotides, microfragmented adipose tissue, and autologous conditioned serum. Study appraisal and synthesis methods: Data extraction and quality assessment were conducted independently. Methodological quality was assessed using the modified Coleman Methodology Score (CMS) and the Cochrane Risk of Bias 2 tool for randomized controlled trials. Results: Twenty-four studies (2027 patients) met inclusion criteria. Thirteen evaluated PRP, seven corticosteroids, and four other injective therapies. The mean CMS was 46/100, indicating overall moderate-to-low quality. PRP demonstrated consistent improvements in pain and function, with surgery-free survival exceeding 80% at mid-term follow-up and limited MRI evidence of structural improvement. Corticosteroids provided short-term symptom relief without structural benefit. Other injective therapies showed promising early results but were limited by small sample sizes and heterogeneity. Adverse events and surgical conversion rates were low across treatments. Limitations: Overall methodological quality was moderate-to-low, with heterogeneity in study design and protocols. Conclusions and implications of key findings: Injective therapies may provide meaningful symptom relief in selected meniscal lesions. PRP shows the most consistent benefit, while other biologic injectives require higher-quality randomized trials to clarify their role. Systematic review registration number: CRD420251233155.