Comparative Efficacy of Platelet-Rich Plasma Injection Alone Versus Arthroscopy Combined with Platelet-Rich Plasma Injection in the Treatment of Stoller Grade I-II Meniscus Tear

Comparative Efficacy of Platelet-Rich Plasma Injection Alone Versus Arthroscopy Combined with Platelet-Rich Plasma Injection in the Treatment of Stoller Grade I-II Meniscus Tear | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparative Efficacy of Platelet-Rich Plasma Injection Alone Versus Arthroscopy Combined with Platelet-Rich Plasma Injection in the Treatment of Stoller Grade I-II Meniscus Tear Pengchao Zhang, Haopeng Luan, Xin Ma, Feierdong Abulizi, Dequan Wang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8077279/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 20 You are reading this latest preprint version Abstract Objective To optimize patient treatment plans, this study compares the early clinical outcomes of PRP injection alone versus arthroscopic surgery combined with PRP for Stoller I-II meniscus tears, analyzing the pros and cons of each treatment and recovery status, and recommends the best clinical strategy based on the severity of the injury. Methods A retrospective study was conducted on patients with Stoller I-II meniscus injuries at the People's Hospital of Xinjiang Uygur Autonomous Region from September 2023 to December 2024. Patients with knee osteoarthritis, cruciate ligament injuries, or other knee issues were excluded. Participants were divided into two treatment groups: PRP injection alone and arthroscopic repair with PRP injection. Efficacy was assessed using the Visual Analog Scale (VAS), Lysholm score, and Japanese Orthopedic Association (JOA) criteria before treatment and at 1, 3, and 6 months post-treatment. Additionally, MRI examinations of the knee joint were performed at the final follow-up to facilitate radiological assessment. Data analysis was performed using SPSS 22.0, employing the Chi-square test for categorical data and repeated measures ANOVA for within-group comparisons over time. Comparisons between the two groups were performed using independent samples t-tests. Results A total of 40 patients were enrolled in the study, with 20 patients allocated to each group. No serious complications were observed in either group following treatment. Compared with pre-treatment, the VAS scores of both groups significantly decreased (P < 0.05) at 1, 3, and 6 months after treatment, while the Lysholm and JOA scores significantly increased (P < 0.05), with statistically significant differences. Furthermore, radiological analysis demonstrated evidence of improvement in MRI images for both groups at the final follow-up when compared to pre-treatment images. Conclusion Platelet-rich plasma (PRP) therapy has been demonstrated to effectively alleviate knee joint pain associated with Stoller grade I-II meniscus tears in the short term, while also enhancing knee joint function. This treatment exhibits promising early efficacy in facilitating meniscus repair. Notably, when compared to arthroscopic surgery combined with PRP, PRP injection alone yields comparable therapeutic outcomes to surgical intervention. Platelet-rich plasma Arthroscopy Meniscus Tear Clinical Efficacy Figures Figure 1 Figure 2 Introduction Meniscus tear (MT) represents a prevalent knee joint injury encountered in clinical practice, with more than 1.7 million individuals worldwide undergoing surgical intervention for MT annually. The etiology of MT is multifactorial, involving factors such as age, occupation, body weight, lifestyle, and sports-related injuries. MT is primarily categorized into traumatic and degenerative types. In younger and middle-aged populations, acute sports injuries or trauma are the predominant causes, whereas chronic wear and tear is the principal cause in middle-aged and elderly individuals[ 1 ]. The intricate structure of the meniscus, coupled with its unique physiological environment, poses challenges to recovery post-injury. MT can lead to further damage to adjacent structures, resulting in knee pain, functional impairment of the knee joint, and potentially progressing to traumatic knee osteoarthritis. Research indicates that the risk of developing secondary knee osteoarthritis following meniscal tears (MT) increases threefold[ 1 , 2 ]. In recent years, the heightened awareness of sports has led to a significant rise in the incidence of MT. However, there remains a lack of consensus regarding the superiority of meniscus surgery versus conservative treatment, and no standardized guidelines exist to assist patients in selecting the most appropriate treatment modality. With advancements in sports and regenerative medicine, platelet-rich plasma (PRP) has emerged as a novel therapeutic option for MT and has been increasingly utilized[ 3 , 4 ]. Currently, a variety of treatment options are available for meniscal injuries in clinical practice, each possessing distinct advantages and disadvantages, yet there is an absence of standardized criteria to guide patient treatment selection. The primary treatment modalities include surgical and conservative approaches. It is generally accepted that conservative management is preferred for Stoller grade I-II injuries, whereas surgical intervention is typically recommended for grade III injuries. With the ongoing advancements in modern sports medicine theories and arthroscopic techniques, arthroscopic surgery has become a relatively routine procedure for addressing meniscal tears. Currently, there are no clinical studies directly comparing the outcomes of arthroscopic surgery combined with platelet-rich plasma (PRP) therapy to PRP injection alone. To address this gap, the author conducted a retrospective review of patients with Stoller grade I-II meniscus injuries who were admitted to our hospital between 2023 and 2024. The objective was to assess the short-term efficacy of these treatment modalities. By evaluating the differences in outcomes between the two treatment strategies, the study aims to identify the most effective clinical approach and contribute to the optimization of treatment plans for patients. Materials and Methods 1.General Information From September 2023 to December 2024, a cohort of 40 patients with Stoller grade I-II meniscus tears was selected from the Pain Management Center and the Department of Orthopedic Sports Medicine at the People's Hospital of Xinjiang Uygur Autonomous Region. These patients were divided into two groups: the PRP injection group (PRP group) and the arthroscopic meniscus repair combined with PRP injection group (combined group), with 20 patients in each group. Both groups underwent a 6-month follow-up period, during which comprehensive pre- and post-treatment imaging examinations and efficacy assessments were conducted. All treatments were administered by the same senior attending physician in the department. The treatments for both groups were administered by the same senior attending physician within the department. All participants received comprehensive information regarding the study and provided written informed consent. The study protocol received approval from the hospital's ethics committee. Inclusion criteria were as follows (1) Participants must meet the diagnostic criteria for meniscus tears as outlined in " 2018 APTA Clinical Practice Guidelines[ 2 ]", irrespective of gender or whether the left or right knee is affected; (2) Participants must exhibit clinical manifestations of meniscus injury, with at least two positive specific signs (such as knee pain, locking, crepitus, a positive McMurray test, or a positive squatting and walking test); (3) MRI examination must confirm a diagnosis of meniscus injury, classified as Stoller grade I-II; (4) Participants in the combined group must have indications for arthroscopic surgery, voluntarily opt for surgical intervention, provide informed consent, and agree to cooperate with platelet-rich plasma (PRP) treatment and participate in follow-up assessments. Exclusion criteria included (1) Patients with a history of knee surgery, Kellgren-Lawrence grade I-IV osteoarthritis, concurrent cruciate ligament injury, or other knee joint injuries were excluded. (2) Patients with diabetes, rheumatic diseases, severe cardiovascular diseases, infections, severe immunosuppressive diseases, hematological disorders, and liver or kidney dysfunction were excluded from the study. (3) Patients who had received other pharmacological treatments, such as anticoagulant therapy within the past week, nonsteroidal anti-inflammatory drugs, or intra-articular injections of corticosteroids or hyaluronic acid within the past two weeks, were also excluded. (4) Additionally, patients with cognitive impairments, mental disorders, malignancies, or those unwilling to cooperate with clinical observations were not included. 2. Treatment Methods : Preparation of Platelet-Rich Plasma (PRP) : PRP is derived from autologous blood through processes such as centrifugation and separation, resulting in a product with a platelet concentration approximately 4 to 6 times higher than that found in normal blood. In this study, PRP was prepared using a double centrifugation technique. The Shanghai Lu Xiangyi blood cell separator and a disposable PRP preparation tube containing sodium citrate as an anticoagulant were employed to produce fresh autologous platelet-rich plasma (PL-PRP). A volume of 15 ml of autologous venous blood was collected from the basilic vein of the left upper limb by nursing staff. The double centrifugation method was utilized to isolate the platelets. The initial centrifugation was conducted at a radius of 15.5 cm and a speed of 1200 revolutions per minute (rpm) for a duration of 10 minutes. Post-centrifugation, the blood was stratified into three distinct layers: the upper serum layer, the lower red blood cell layer, and the intermediate buffy coat, which contains platelets, white blood cells, and other components. The red blood cells located beneath the buffy coat were carefully aspirated using a syringe and subsequently discarded. The remaining portion of the sample was subjected to a second centrifugation process using a centrifuge with a radius of 15.5 cm, operating at a speed of 2800 revolutions per minute for a duration of 10 minutes. Post-centrifugation, the sample stratified into two distinct layers: the upper layer, identified as platelet-poor plasma (PPP), and the lower layer, designated as platelet-rich plasma (PRP). The PPP was carefully aspirated using a syringe, leaving behind 5 ml of PRP for injection purposes. Injection Protocol for the PRP Group Patients were positioned supine with the affected knee exposed, externally rotated, and flexed. Standard disinfection and draping procedures were employed. Ultrasound imaging was utilized to accurately locate the meniscus, and 5 ml of PRP was injected perimeniscally under ultrasound guidance. Following the injection, the needle was withdrawn, and the puncture site was covered with a sterile dressing. Patients were advised to refrain from weight-bearing activities, squatting, and running for 48 hours post-injection and to avoid vigorous knee joint movements for a period of two weeks. PRP injections were administered biweekly, totaling three sessions. Arthroscopic Meniscus Repair in the Combined Group Patients underwent surgery in the supine position. All procedures in this study were conducted under epidural and subarachnoid block anesthesia. The Smith & Nephew arthroscopic system was utilized to examine and debride various components of the knee joint. Meniscus suturing was performed based on the specific nature of the meniscal injury. In instances where the anterior horn was unsuitable for direct suturing, the damaged meniscal fragments were excised, while efforts were made to suture and preserve as much of the larger meniscal tissue as possible. Following incision closure, 5 ml of platelet-rich plasma (PRP) was injected once into the joint cavity on the affected side, and compression dressing was applied using an elastic bandage. 3.Efficacy Evaluation The efficacy of MT treatment was assessed utilizing the VAS, Lysholm score, and Japanese Orthopedic Association (JOA) criteria at baseline and at 1, 3, and 6 months post-treatment. Complications were systematically monitored throughout the study. Consistency in patient evaluation was maintained by having the same medical personnel conduct examinations and scoring both before and after treatment. MRI examinations were conducted prior to treatment initiation and at the final follow-up. 4.Statistical Methods Data analysis was conducted using SPSS statistical software version 22.0. Descriptive statistics for measurement data were presented as mean ± standard deviation (x̄ ± s). The chi-square test was employed for comparing categorical data. Repeated measures analysis of variance (ANOVA) was utilized for intra-group comparisons at different time points, while independent samples t-tests were used for inter-group comparisons at each time point. A significance level of α = 0.05 was adopted for all statistical tests, with P < 0.05 indicating a statistically significant difference. Results Among the 40 participants, 28 were male and 12 were female, with a mean age of 43.48 ± 6.85 years. In the PRP group, there were 13 males and 7 females, aged between 31 and 53 years; according to Stoller grading, 12 patients were classified as grade I and 8 as grade II(Figure 1 ). In the combined group, there were 15 males and 5 females, aged between 32 and 56 years; 11 patients were classified as Stoller grade I and 9 as grade II༈Figure 2 ༉. All participants successfully completed the 6-month follow-up period, during which assessments of pain and knee joint function were performed for all patients. During the course of treatment, 4 patients experienced mild postoperative joint swelling and restricted mobility, which resolved within 48 hours with the application of local ice packs, activity limitations, or oral analgesics. No other patients encountered significant complications. The majority of patients in both cohorts exhibited radiological evidence of meniscus improvement on MRI at the final follow-up. There were no statistically significant differences between the two groups concerning age, gender, BMI, and Stoller meniscus injury grading ( P > 0.05, Table 1 ). Table 1 Comparison of Baseline Data Before Treatment Between the Two Groups Group Number of Cases Age (years, x ± s) Gender (Male/Female) Stoller Grading (I/II) BMI (kg/m², x ± s) PRP Group 20 42 ± 6 13/7 12/8 26.7 ± 1.3 Combined Group 20 45 ± 7 15/5 11/9 27.2 ± 0.9 Statistical Values P Values t=-9.450 >0.05 X²=0.143 >0.05 X²=0.102 >0.05 t =-1.388 >0.05 At 1, 3, and 6 months post-treatment, the VAS scores in both patient groups were significantly reduced compared to pre-treatment levels ( P < 0.05). Concurrently, the Lysholm and JOA scores in both groups showed significant improvement at these same intervals. Notably, the JOA scores in the PRP group were higher than those in the combined treatment group at 1 and 6 months post-treatment ( P 0.05) (Tables 2 , 3 , and 4 ). Table 2 Comparison of VAS Scores Between the Two Groups (x-±s) Group Number of Cases Preoperative postoperative one month Postoperative three month Postoperative six month P Values PRP Group 20 6.00 ± 0.80 2.30 ± 0.66 1.50 ± 0.61 1.15 ± 0.59 <0.05 Combined Group 20 6.20 ± 0.70 2.45 ± 0.51 1.85 ± 0.49 1.00 ± 0.46 0.05 -0.81 >0.05 -2.01 >0.05 0.90 >0.05 Table 3 Comparison of Lysholm Scores Between the Two Groups (x-±s) Group Number of Cases Preoperative postoperative one month Postoperative three month Postoperative six month P Values PRP Group 20 61.00 ± 6.37 72.45 ± 5.92 80.50 ± 4.48 87.20 ± 3.47 <0.05 Combined Group 20 57.70 ± 4.83 70.40 ± 4.87 78.80 ± 3.47 86.20 ± 3.00 0.05 1.20 >0.05 1.03 >0.05 0.97 >0.05 Table 4 Comparison of JOA Scores Between the Two Groups (x-±s) Group Number of Cases Preoperative postoperative one month Postoperative three month Postoperative six month P Values PRP Group 20 59.45 ± 6.12 70.50 ± 5.92 79.50 ± 5.92 81.00 ± 4.19 <0.05 Combined Group 20 56.50 ± 3.74 67.20 ± 4.10 76.15 ± 4.13 81.45 ± 2.84 0.05 <0.05 0.05 Discussion The meniscus receives its blood supply from the capillary plexus of the medial and lateral arteries of the knee joint, located within the joint capsule and synovial tissue. Based on its vascularization, the meniscus is categorized into three zones: Zone I (red zone), Zone II (red-white zone), and Zone III (white zone). Zones I and II have some blood supply, which confers a degree of healing capacity in the event of injury. In contrast, Zone III, which constitutes the inner third of the meniscus, lacks blood supply and is generally considered non-healing when injured. Consequently, PRP treatment is a viable option for meniscal tears of Grades I to III[ 5 ]. The meniscus is a crucial component of the knee joint, serving functions such as joint lubrication, shock absorption, load transmission, and the maintenance of knee joint stability. Clinically, MT primarily manifest as knee pain, swelling, and restricted mobility. As the condition advances, additional symptoms may include knee crepitus, joint locking, and quadriceps atrophy. If left untreated, MT can progress to secondary traumatic knee osteoarthritis, leading to significant consequences such as the deterioration of knee joint function. Consequently, MT can be considered an early stage of knee osteoarthritis. With ongoing advancements in medical technology, a growing body of research[ 3 , 4 , 6 , 7 ] has explored the effects of platelet-rich plasma (PRP) in treating meniscus injuries. Recently, a study by Xie et al.[ 8 ] involved administering postoperative PRP injections to patients following arthroscopic surgery, and it was reported that PRP can enhance joint mobility and knee function in individuals with meniscus injuries. Everhart et al.[ 9 ] conducted two studies involving a total of 550 patients, demonstrating that arthroscopic surgery combined with platelet-rich plasma (PRP) treatment can enhance meniscus repair and significantly reduce the reoperation rate. Kaminski et al.[ 10 ] performed a randomized trial with 37 patients who had complete vertical meniscus tears, revealing that PRP treatment can markedly improve the healing rate of meniscus repair surgery. To further substantiate the efficacy and safety of PRP in meniscus repair, Kaminski et al.[ 11 ] published an additional clinical trial in 2019. Magnetic Resonance Imaging (MRI) and arthroscopic evaluations at week 33 indicated a significantly higher healing rate in the PRP group, with outcomes notably superior to those of the control group. Several studies suggest that PRP can enhance the meniscus repair rate and decrease the likelihood of secondary surgery. Sakti et al.[ 12 ] meta-analysis concluded that PRP can reduce the failure rate of meniscus repair. Xie et al.[ 8 , 13 ] meta-analysis, which encompassed 17 RCTs with a total of 776 participants, reported that PRP combined with surgical intervention can safely and effectively improve the outcomes of meniscus repair. Li et al.[ 14 ] conducted a meta-analysis comparing traditional arthroscopic meniscus suture with arthroscopic surgery combined with platelet-rich plasma (PRP) for the treatment of meniscus tears. This analysis included two randomized controlled trials (RCTs) and seven non-randomized controlled trials (non-RCTs), concluding that the combined treatment demonstrated superior efficacy. In recent years, monotherapy with PRP injections has also shown promising therapeutic outcomes[ 15 , 16 ]. Raju et al.[ 17 ] conducted a prospective study indicating that PRP injection alone can effectively alleviate pain and enhance knee function following meniscus injury. Thirugnana et al.[ 18 ] performed ultrasound-guided intra-meniscal PRP injections in their study cohort and conducted follow-ups over an average duration of 32 months. The results demonstrated significant improvements in both Lysholm scores and MRI assessments. Furthermore, the study by Ivan et al.[ 19 ] indicated that PRP not only enhances knee function but also facilitates the healing of meniscus tears. These findings align with the results of our current study. Both arthroscopic surgery combined with PRP treatment and PRP injection alone have been shown to improve pain symptoms and knee function in MT, with MRI evidence indicating meniscus healing. Currently, there is a paucity of comparative clinical studies examining arthroscopic surgery versus pure platelet-rich plasma (PRP) injection treatment. This study seeks to address this gap by evaluating the necessity of arthroscopic surgery. Our findings indicate that conservative treatment with pure PRP injections can alleviate pain symptoms and enhance knee joint function in patients with meniscal tears (MT), achieving outcomes comparable to those of arthroscopic surgery combined with treatment. Notably, PRP injections may offer advantages in short- to medium-term functional recovery, potentially due to factors such as postoperative compression bandaging and immobilization associated with arthroscopic surgery. In recent years, several studies[ 20 – 22 ] have suggested that the combination of platelet-rich plasma (PRP) with arthroscopic meniscus repair surgery may have limited efficacy in enhancing postoperative knee pain relief and functional outcomes. Weldon et al.[ 23 ] case-control study indicated that PRP does not significantly improve postoperative pain, potentially due to the high levels of tumor necrosis factor present in conventional PRP preparations. Furthermore, some research has identified body mass index (BMI) and age as critical factors influencing the recovery time of knee joint function. For obese and elderly patients, the beneficial effects of PRP injections following arthroscopic surgery on knee joint function recovery may be restricted. In past clinical treatments, our team has summarized several important cautions regarding PRP injections. Prior to PRP administration, it is advisable to conduct an ultrasound or MRI assessment of the knee joint. If joint effusion is detected, it should be aspirated before PRP injection to prevent excessive dilution of the PRP, which could compromise its therapeutic efficacy. In this study, we employed ultrasound-guided PRP injection techniques, allowing for the observation and aspiration of joint effusion to prevent dilution of the PRP concentration during injection. Simultaneously, the position of the meniscus can be accurately identified using ultrasound, allowing for more precise application of platelet-rich plasma (PRP) around the meniscus. The use of leukocyte-poor PRP (LP-PRP) is advocated for intra-articular injection therapy of the knee joint[ 24 ]. Several studies suggest that the administration of leukocyte-rich PRP (LR-PRP) into the joint cavity may provoke synovitis, and the structural benefits post-injection are considerably lower compared to LP-PRP. It is advisable to utilize autologous PRP with a concentration ranging from four to six times for intra-articular injection treatment of the knee joint, with a recommended single injection volume of 4 to 8 ml. The efficacy of PRP in enhancing cell proliferation is positively correlated with its platelet concentration[ 25 ]. Insufficient platelet concentration may result in a negligible reparative effect. PRP should be freshly prepared and administered promptly to preserve its optimal biological activity. If immediate administration is not feasible, PRP should be maintained in a sterile environment and stored at low temperatures to preserve its biological activity and stability. Following a PRP injection, patients may experience varying degrees of joint swelling, increased skin temperature, and exacerbated pain lasting from one to several days. It is advisable for patients to apply local ice packs and limit physical activity for 48 hours to prevent excessive weight-bearing, squatting, stair climbing, and other strenuous activities such as running and jumping. Furthermore, patients with MT in the acute edema phase or those with concurrent bleeding are not recommended to undergo immediate PRP treatment, as the therapeutic effect may be suboptimal and pain may be exacerbated. In such cases, it is preferable to drain the joint effusion and administer corticosteroids to alleviate acute inflammation. PRP treatment should be considered only after the anti-inflammatory effects of corticosteroids have subsided[ 5 ]. However, the retrospective design and limited sample size of this study present certain limitations. Additionally, this study focuses on Stoller grade I-II meniscal injuries, and its efficacy for grade III or more severe injuries remains unclear. Future research should involve large-sample, prospective clinical studies with long-term follow-up and high-quality randomized controlled trials to substantiate the efficacy of PRP in treating meniscal injuries. Conclusion Platelet-rich plasma (PRP) therapy significantly attenuates knee pain and improves short-term functional outcomes in patients with Stoller grade I–II meniscal lesions, implying its capacity to expedite tissue healing. Compared with arthroscopic surgery combined with adjunctive interventions, isolated PRP injection yields equivalent clinical efficacy while conferring superior early functional recovery and accelerated rehabilitation. Declarations Availability of data and material The data sets generated and analyzed during the current study are not publicly available due to restrictions on ethical approvals involving patient data and anonymity but can be obtained from the corresponding author on reasonable request. Competing interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Ethics approval and consent to participate This retrospective study was approved by the Ethics Committee of the People's Hospital of Xinjiang Uygur Autonomous Region and carried out by the ethical standards set out in the Helsinki Declaration. Informed consent was received from all participants. Ethical batch number: YK20251013 Funding information This study was not funded by any foundation. Author Contributions PCZ and HPL developed the research questions and scope of the study. XM and FA conducted preoperative and postoperative data screening, and data charting. PCZ drafted the manuscript, and prepared tables, and figures with HPL’s contribution. XM developed the literature search strategies in collaboration with the other authors. PCZ, HPL, XM, and FA contributed to the organization, analysis, and interpretation of the results. All authors read and approved the final manuscript. Acknowledgements Not applicable. References Adams BG, Houston MN, Cameron KL. The Epidemiology of Meniscus Injury. Sports Med Arthrosc Rev. 2021;29(3):e24–33. Nazari G. Appraisal of Clinical Practice Guideline: Knee Pain and Mobility Impairments: Meniscal and Articular Cartilage Lesions Revision 2018. J Physiother. 2019;65(1):57. Gopinatth V, Batra AK, Chahla J, Smith MV, Matava MJ, Brophy RH, Knapik DM. Degenerative Meniscus Tears Treated Nonoperatively With Platelet-Rich Plasma Yield Variable Clinical and Imaging Outcomes: A Systematic Review. 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Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzUlEQVRIiWNgGAWjYBAC+2b2Awc+VNjU87M3EKnFgL0n8eCMM2kJkj0HiNXCc8D4MG/boQSDGwlEajGXSEg4wMN2IE9y5uONNxhqbKIJarGckXjggATPnWJ+6bRiC4ZjabkNBPXcANpiIPGMcebsHDMJxobDRGkxOJBgcJhxw80zRGoxOHPA4MCBhMOJG27wEKlFsr0n4WDDgTRjyR6gXxKI8Qs/M/vhz3//2cjxsx/eeONDjQ0RfkF2pEQCKcohWkjVMQpGwSgYBSMDAACMTEmYAV5p3wAAAABJRU5ErkJggg==","orcid":"","institution":"People's Hospital of Xinjiang Uygur Autonomous Region","correspondingAuthor":true,"prefix":"","firstName":"Dequan","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2025-11-10 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07:01:39","extension":"xml","order_by":13,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":92618,"visible":true,"origin":"","legend":"","description":"","filename":"8cfd0a31a5fe47f287332f96485bc6141structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8077279/v1/ceb92878875f060a61b8ce3f.xml"},{"id":97654640,"identity":"6ef8b8a1-3437-490f-a181-a2672abd172b","added_by":"auto","created_at":"2025-12-08 07:01:39","extension":"html","order_by":14,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":100431,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8077279/v1/9a830d6f84a6327f2ac3cbb9.html"},{"id":97654643,"identity":"401a0545-28ea-4679-b484-3e82172b88a4","added_by":"auto","created_at":"2025-12-08 07:01:39","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":179476,"visible":true,"origin":"","legend":"\u003cp\u003eIn the context of a 40-45-year-old patient admitted with a diagnosis of a medial meniscus tear in the right knee, physical examination revealed slight swelling of the right knee joint relative to the contralateral side, marked tenderness in the medial space of the right knee joint, a positive McMurray's sign, and a reduced range of motion in the right knee joint compared to the contralateral side. Radiographic examination did not reveal any significant abnormalities in the right knee joint (A), while MRI indicated a grade I injury of the medial meniscus (B). The therapeutic protocol consisted of administering ultrasound-guided platelet-rich plasma (PRP) injections to the medial meniscus of the right knee biweekly, culminating in a total of three treatments. A follow-up magnetic resonance imaging (MRI) scan conducted six months post-treatment revealed a progressive normalization of the right knee meniscus morphology (C). D depicts the double centrifugation technique employed for platelet separation, during which 5 mL of the upper layer, identified as platelet-rich plasma (LP-PRP), was extracted. E illustrates the meniscus morphology as observed via ultrasound imaging: the patient was positioned supine with the right knee exposed, externally rotated, and flexed. The high-frequency ultrasound probe's reference mark was positioned on the medial epicondyle of the femur, while the opposite end was placed on the medial condyle of the tibia. The ultrasound imaging revealed the medial meniscus situated within the \"V\"-shaped region between the femoral and tibial cortices, appearing as a medium-high echo triangular structure. F demonstrates the administration of 5 mL of autologous PRP under ultrasound guidance.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8077279/v1/249f5e639e39009d5655fb62.png"},{"id":97654634,"identity":"581ee85c-b12a-4c1c-b10e-7589d6429fe5","added_by":"auto","created_at":"2025-12-08 07:01:38","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":450303,"visible":true,"origin":"","legend":"\u003cp\u003eIn the context of a 42-46-year-old patient admitted to the hospital with a diagnosis of a grade II injury to the medial meniscus of the left knee. The patient had previously undergone conservative treatments including physical therapy and oral nonsteroidal anti-inflammatory drugs (NSAIDs) for 6 months without significant improvement. MRI examination confirmed a grade II injury, characterized by the anterior horn of the meniscus being indistinct and the posterior horn exhibiting a curled abnormal signal, as indicated by the arrow (A). The treatment approach consisted of an arthroscopic meniscus suture in conjunction with a PRP injection (C-E). A follow-up MRI conducted six months post-surgery demonstrated improvement in the meniscus injury, with the anterior and posterior horns of the meniscus regaining a triangular shape and exhibiting slightly lower signal intensity (B).\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8077279/v1/e6d92ea40b75fcb8e2cdf6fb.png"},{"id":97678766,"identity":"017c1966-5c58-45a2-9f85-e90ab8f4e400","added_by":"auto","created_at":"2025-12-08 09:56:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1505482,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8077279/v1/f87053fb-ec26-431c-a71a-9b7a9b99a811.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparative Efficacy of Platelet-Rich Plasma Injection Alone Versus Arthroscopy Combined with Platelet-Rich Plasma Injection in the Treatment of Stoller Grade I-II Meniscus Tear","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMeniscus tear (MT) represents a prevalent knee joint injury encountered in clinical practice, with more than 1.7\u0026nbsp;million individuals worldwide undergoing surgical intervention for MT annually. The etiology of MT is multifactorial, involving factors such as age, occupation, body weight, lifestyle, and sports-related injuries. MT is primarily categorized into traumatic and degenerative types. In younger and middle-aged populations, acute sports injuries or trauma are the predominant causes, whereas chronic wear and tear is the principal cause in middle-aged and elderly individuals[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The intricate structure of the meniscus, coupled with its unique physiological environment, poses challenges to recovery post-injury. MT can lead to further damage to adjacent structures, resulting in knee pain, functional impairment of the knee joint, and potentially progressing to traumatic knee osteoarthritis. Research indicates that the risk of developing secondary knee osteoarthritis following meniscal tears (MT) increases threefold[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In recent years, the heightened awareness of sports has led to a significant rise in the incidence of MT. However, there remains a lack of consensus regarding the superiority of meniscus surgery versus conservative treatment, and no standardized guidelines exist to assist patients in selecting the most appropriate treatment modality. With advancements in sports and regenerative medicine, platelet-rich plasma (PRP) has emerged as a novel therapeutic option for MT and has been increasingly utilized[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eCurrently, a variety of treatment options are available for meniscal injuries in clinical practice, each possessing distinct advantages and disadvantages, yet there is an absence of standardized criteria to guide patient treatment selection. The primary treatment modalities include surgical and conservative approaches. It is generally accepted that conservative management is preferred for Stoller grade I-II injuries, whereas surgical intervention is typically recommended for grade III injuries. With the ongoing advancements in modern sports medicine theories and arthroscopic techniques, arthroscopic surgery has become a relatively routine procedure for addressing meniscal tears. Currently, there are no clinical studies directly comparing the outcomes of arthroscopic surgery combined with platelet-rich plasma (PRP) therapy to PRP injection alone. To address this gap, the author conducted a retrospective review of patients with Stoller grade I-II meniscus injuries who were admitted to our hospital between 2023 and 2024. The objective was to assess the short-term efficacy of these treatment modalities. By evaluating the differences in outcomes between the two treatment strategies, the study aims to identify the most effective clinical approach and contribute to the optimization of treatment plans for patients.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cb\u003e1.General Information\u003c/b\u003e\u003c/p\u003e\u003cp\u003eFrom September 2023 to December 2024, a cohort of 40 patients with Stoller grade I-II meniscus tears was selected from the Pain Management Center and the Department of Orthopedic Sports Medicine at the People's Hospital of Xinjiang Uygur Autonomous Region. These patients were divided into two groups: the PRP injection group (PRP group) and the arthroscopic meniscus repair combined with PRP injection group (combined group), with 20 patients in each group. Both groups underwent a 6-month follow-up period, during which comprehensive pre- and post-treatment imaging examinations and efficacy assessments were conducted. All treatments were administered by the same senior attending physician in the department. The treatments for both groups were administered by the same senior attending physician within the department. All participants received comprehensive information regarding the study and provided written informed consent. The study protocol received approval from the hospital's ethics committee.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eInclusion criteria were as follows\u003c/strong\u003e\u003cp\u003e(1) Participants must meet the diagnostic criteria for meniscus tears as outlined in \" 2018 APTA Clinical Practice Guidelines[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\", irrespective of gender or whether the left or right knee is affected; (2) Participants must exhibit clinical manifestations of meniscus injury, with at least two positive specific signs (such as knee pain, locking, crepitus, a positive McMurray test, or a positive squatting and walking test); (3) MRI examination must confirm a diagnosis of meniscus injury, classified as Stoller grade I-II; (4) Participants in the combined group must have indications for arthroscopic surgery, voluntarily opt for surgical intervention, provide informed consent, and agree to cooperate with platelet-rich plasma (PRP) treatment and participate in follow-up assessments.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eExclusion criteria included\u003c/strong\u003e\u003cp\u003e(1) Patients with a history of knee surgery, Kellgren-Lawrence grade I-IV osteoarthritis, concurrent cruciate ligament injury, or other knee joint injuries were excluded. (2) Patients with diabetes, rheumatic diseases, severe cardiovascular diseases, infections, severe immunosuppressive diseases, hematological disorders, and liver or kidney dysfunction were excluded from the study. (3) Patients who had received other pharmacological treatments, such as anticoagulant therapy within the past week, nonsteroidal anti-inflammatory drugs, or intra-articular injections of corticosteroids or hyaluronic acid within the past two weeks, were also excluded. (4) Additionally, patients with cognitive impairments, mental disorders, malignancies, or those unwilling to cooperate with clinical observations were not included.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e2. Treatment Methods\u003c/b\u003e:\u003c/p\u003e\u003cp\u003e\u003cb\u003ePreparation of Platelet-Rich Plasma (PRP)\u003c/b\u003e: PRP is derived from autologous blood through processes such as centrifugation and separation, resulting in a product with a platelet concentration approximately 4 to 6 times higher than that found in normal blood. In this study, PRP was prepared using a double centrifugation technique. The Shanghai Lu Xiangyi blood cell separator and a disposable PRP preparation tube containing sodium citrate as an anticoagulant were employed to produce fresh autologous platelet-rich plasma (PL-PRP). A volume of 15 ml of autologous venous blood was collected from the basilic vein of the left upper limb by nursing staff. The double centrifugation method was utilized to isolate the platelets. The initial centrifugation was conducted at a radius of 15.5 cm and a speed of 1200 revolutions per minute (rpm) for a duration of 10 minutes. Post-centrifugation, the blood was stratified into three distinct layers: the upper serum layer, the lower red blood cell layer, and the intermediate buffy coat, which contains platelets, white blood cells, and other components. The red blood cells located beneath the buffy coat were carefully aspirated using a syringe and subsequently discarded. The remaining portion of the sample was subjected to a second centrifugation process using a centrifuge with a radius of 15.5 cm, operating at a speed of 2800 revolutions per minute for a duration of 10 minutes. Post-centrifugation, the sample stratified into two distinct layers: the upper layer, identified as platelet-poor plasma (PPP), and the lower layer, designated as platelet-rich plasma (PRP). The PPP was carefully aspirated using a syringe, leaving behind 5 ml of PRP for injection purposes.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eInjection Protocol for the PRP Group\u003c/strong\u003e\u003cp\u003ePatients were positioned supine with the affected knee exposed, externally rotated, and flexed. Standard disinfection and draping procedures were employed. Ultrasound imaging was utilized to accurately locate the meniscus, and 5 ml of PRP was injected perimeniscally under ultrasound guidance. Following the injection, the needle was withdrawn, and the puncture site was covered with a sterile dressing. Patients were advised to refrain from weight-bearing activities, squatting, and running for 48 hours post-injection and to avoid vigorous knee joint movements for a period of two weeks. PRP injections were administered biweekly, totaling three sessions.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eArthroscopic Meniscus Repair in the Combined Group\u003c/strong\u003e\u003cp\u003ePatients underwent surgery in the supine position. All procedures in this study were conducted under epidural and subarachnoid block anesthesia. The Smith \u0026amp; Nephew arthroscopic system was utilized to examine and debride various components of the knee joint. Meniscus suturing was performed based on the specific nature of the meniscal injury. In instances where the anterior horn was unsuitable for direct suturing, the damaged meniscal fragments were excised, while efforts were made to suture and preserve as much of the larger meniscal tissue as possible. Following incision closure, 5 ml of platelet-rich plasma (PRP) was injected once into the joint cavity on the affected side, and compression dressing was applied using an elastic bandage.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e3.Efficacy Evaluation\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe efficacy of MT treatment was assessed utilizing the VAS, Lysholm score, and Japanese Orthopedic Association (JOA) criteria at baseline and at 1, 3, and 6 months post-treatment. Complications were systematically monitored throughout the study. Consistency in patient evaluation was maintained by having the same medical personnel conduct examinations and scoring both before and after treatment. MRI examinations were conducted prior to treatment initiation and at the final follow-up.\u003c/p\u003e\u003cp\u003e\u003cb\u003e4.Statistical Methods\u003c/b\u003e\u003c/p\u003e\u003cp\u003eData analysis was conducted using SPSS statistical software version 22.0. Descriptive statistics for measurement data were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (x̄ \u0026plusmn; s). The chi-square test was employed for comparing categorical data. Repeated measures analysis of variance (ANOVA) was utilized for intra-group comparisons at different time points, while independent samples t-tests were used for inter-group comparisons at each time point. A significance level of α\u0026thinsp;=\u0026thinsp;0.05 was adopted for all statistical tests, with \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 indicating a statistically significant difference.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAmong the 40 participants, 28 were male and 12 were female, with a mean age of 43.48\u0026thinsp;\u0026plusmn;\u0026thinsp;6.85 years. In the PRP group, there were 13 males and 7 females, aged between 31 and 53 years; according to Stoller grading, 12 patients were classified as grade I and 8 as grade II(Figure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). In the combined group, there were 15 males and 5 females, aged between 32 and 56 years; 11 patients were classified as Stoller grade I and 9 as grade II༈Figure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e༉. All participants successfully completed the 6-month follow-up period, during which assessments of pain and knee joint function were performed for all patients. During the course of treatment, 4 patients experienced mild postoperative joint swelling and restricted mobility, which resolved within 48 hours with the application of local ice packs, activity limitations, or oral analgesics. No other patients encountered significant complications. The majority of patients in both cohorts exhibited radiological evidence of meniscus improvement on MRI at the final follow-up. There were no statistically significant differences between the two groups concerning age, gender, BMI, and Stoller meniscus injury grading (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05, Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of Baseline Data Before Treatment Between the Two Groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumber of Cases\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAge (years, x\u0026thinsp;\u0026plusmn;\u0026thinsp;s)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eGender (Male/Female)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eStoller Grading (I/II)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eBMI (kg/m\u0026sup2;, x\u0026thinsp;\u0026plusmn;\u0026thinsp;s)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePRP Group\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e42\u0026thinsp;\u0026plusmn;\u0026thinsp;6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13/7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12/8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e26.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCombined Group\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e45\u0026thinsp;\u0026plusmn;\u0026thinsp;7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15/5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11/9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e27.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eStatistical Values\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eP\u003c/b\u003e \u003cb\u003eValues\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003et=-9.450\u003c/p\u003e\u003cp\u003e\u0026gt;0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eX\u0026sup2;=0.143\u003c/p\u003e\u003cp\u003e\u0026gt;0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eX\u0026sup2;=0.102\u003c/p\u003e\u003cp\u003e\u0026gt;0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003et =-1.388\u003c/p\u003e\u003cp\u003e\u0026gt;0.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAt 1, 3, and 6 months post-treatment, the VAS scores in both patient groups were significantly reduced compared to pre-treatment levels (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Concurrently, the Lysholm and JOA scores in both groups showed significant improvement at these same intervals. Notably, the JOA scores in the PRP group were higher than those in the combined treatment group at 1 and 6 months post-treatment (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). However, there were no statistically significant differences between the two groups overall (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Tables\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, and \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of VAS Scores Between the Two Groups (x-\u0026plusmn;s)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumber of Cases\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePreoperative\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003epostoperative one month\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePostoperative three month\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePostoperative six month\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e Values\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePRP Group\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.30\u0026thinsp;\u0026plusmn;\u0026thinsp;0.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.15\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;0.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCombined Group\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.20\u0026thinsp;\u0026plusmn;\u0026thinsp;0.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.85\u0026thinsp;\u0026plusmn;\u0026thinsp;0.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;0.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003et Value\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eP\u003c/b\u003e \u003cb\u003eValues\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.85\u003c/p\u003e\u003cp\u003e\u0026gt;0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.81\u003c/p\u003e\u003cp\u003e\u0026gt;0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-2.01\u003c/p\u003e\u003cp\u003e\u0026gt;0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.90\u003c/p\u003e\u003cp\u003e\u0026gt;0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of Lysholm Scores Between the Two Groups (x-\u0026plusmn;s)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumber of Cases\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePreoperative\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003epostoperative one month\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePostoperative three month\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePostoperative six month\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e Values\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePRP Group\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e61.00\u0026thinsp;\u0026plusmn;\u0026thinsp;6.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e72.45\u0026thinsp;\u0026plusmn;\u0026thinsp;5.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e80.50\u0026thinsp;\u0026plusmn;\u0026thinsp;4.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e87.20\u0026thinsp;\u0026plusmn;\u0026thinsp;3.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;0.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCombined Group\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e57.70\u0026thinsp;\u0026plusmn;\u0026thinsp;4.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e70.40\u0026thinsp;\u0026plusmn;\u0026thinsp;4.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e78.80\u0026thinsp;\u0026plusmn;\u0026thinsp;3.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e86.20\u0026thinsp;\u0026plusmn;\u0026thinsp;3.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;0.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003et Value\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eP\u003c/b\u003e \u003cb\u003eValues\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.85\u003c/p\u003e\u003cp\u003e\u0026gt;0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.20\u003c/p\u003e\u003cp\u003e\u0026gt;0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.03\u003c/p\u003e\u003cp\u003e\u0026gt;0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.97\u003c/p\u003e\u003cp\u003e\u0026gt;0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of JOA Scores Between the Two Groups (x-\u0026plusmn;s)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumber of Cases\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePreoperative\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003epostoperative one month\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePostoperative three month\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePostoperative six month\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eP Values\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePRP Group\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e59.45\u0026thinsp;\u0026plusmn;\u0026thinsp;6.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e70.50\u0026thinsp;\u0026plusmn;\u0026thinsp;5.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e79.50\u0026thinsp;\u0026plusmn;\u0026thinsp;5.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e81.00\u0026thinsp;\u0026plusmn;\u0026thinsp;4.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;0.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCombined Group\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e56.50\u0026thinsp;\u0026plusmn;\u0026thinsp;3.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e67.20\u0026thinsp;\u0026plusmn;\u0026thinsp;4.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e76.15\u0026thinsp;\u0026plusmn;\u0026thinsp;4.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e81.45\u0026thinsp;\u0026plusmn;\u0026thinsp;2.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;0.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003et Value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-3.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eP Values\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026gt;0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026gt;0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe meniscus receives its blood supply from the capillary plexus of the medial and lateral arteries of the knee joint, located within the joint capsule and synovial tissue. Based on its vascularization, the meniscus is categorized into three zones: Zone I (red zone), Zone II (red-white zone), and Zone III (white zone). Zones I and II have some blood supply, which confers a degree of healing capacity in the event of injury. In contrast, Zone III, which constitutes the inner third of the meniscus, lacks blood supply and is generally considered non-healing when injured. Consequently, PRP treatment is a viable option for meniscal tears of Grades I to III[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The meniscus is a crucial component of the knee joint, serving functions such as joint lubrication, shock absorption, load transmission, and the maintenance of knee joint stability. Clinically, MT primarily manifest as knee pain, swelling, and restricted mobility. As the condition advances, additional symptoms may include knee crepitus, joint locking, and quadriceps atrophy. If left untreated, MT can progress to secondary traumatic knee osteoarthritis, leading to significant consequences such as the deterioration of knee joint function. Consequently, MT can be considered an early stage of knee osteoarthritis. With ongoing advancements in medical technology, a growing body of research[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] has explored the effects of platelet-rich plasma (PRP) in treating meniscus injuries.\u003c/p\u003e\u003cp\u003eRecently, a study by Xie et al.[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] involved administering postoperative PRP injections to patients following arthroscopic surgery, and it was reported that PRP can enhance joint mobility and knee function in individuals with meniscus injuries. Everhart et al.[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] conducted two studies involving a total of 550 patients, demonstrating that arthroscopic surgery combined with platelet-rich plasma (PRP) treatment can enhance meniscus repair and significantly reduce the reoperation rate. Kaminski et al.[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] performed a randomized trial with 37 patients who had complete vertical meniscus tears, revealing that PRP treatment can markedly improve the healing rate of meniscus repair surgery. To further substantiate the efficacy and safety of PRP in meniscus repair, Kaminski et al.[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] published an additional clinical trial in 2019. Magnetic Resonance Imaging (MRI) and arthroscopic evaluations at week 33 indicated a significantly higher healing rate in the PRP group, with outcomes notably superior to those of the control group. Several studies suggest that PRP can enhance the meniscus repair rate and decrease the likelihood of secondary surgery. Sakti et al.[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] meta-analysis concluded that PRP can reduce the failure rate of meniscus repair. Xie et al.[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] meta-analysis, which encompassed 17 RCTs with a total of 776 participants, reported that PRP combined with surgical intervention can safely and effectively improve the outcomes of meniscus repair. Li et al.[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] conducted a meta-analysis comparing traditional arthroscopic meniscus suture with arthroscopic surgery combined with platelet-rich plasma (PRP) for the treatment of meniscus tears. This analysis included two randomized controlled trials (RCTs) and seven non-randomized controlled trials (non-RCTs), concluding that the combined treatment demonstrated superior efficacy.\u003c/p\u003e\u003cp\u003eIn recent years, monotherapy with PRP injections has also shown promising therapeutic outcomes[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Raju et al.[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] conducted a prospective study indicating that PRP injection alone can effectively alleviate pain and enhance knee function following meniscus injury. Thirugnana et al.[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] performed ultrasound-guided intra-meniscal PRP injections in their study cohort and conducted follow-ups over an average duration of 32 months. The results demonstrated significant improvements in both Lysholm scores and MRI assessments. Furthermore, the study by Ivan et al.[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] indicated that PRP not only enhances knee function but also facilitates the healing of meniscus tears. These findings align with the results of our current study. Both arthroscopic surgery combined with PRP treatment and PRP injection alone have been shown to improve pain symptoms and knee function in MT, with MRI evidence indicating meniscus healing.\u003c/p\u003e\u003cp\u003eCurrently, there is a paucity of comparative clinical studies examining arthroscopic surgery versus pure platelet-rich plasma (PRP) injection treatment. This study seeks to address this gap by evaluating the necessity of arthroscopic surgery. Our findings indicate that conservative treatment with pure PRP injections can alleviate pain symptoms and enhance knee joint function in patients with meniscal tears (MT), achieving outcomes comparable to those of arthroscopic surgery combined with treatment. Notably, PRP injections may offer advantages in short- to medium-term functional recovery, potentially due to factors such as postoperative compression bandaging and immobilization associated with arthroscopic surgery. In recent years, several studies[\u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] have suggested that the combination of platelet-rich plasma (PRP) with arthroscopic meniscus repair surgery may have limited efficacy in enhancing postoperative knee pain relief and functional outcomes. Weldon et al.[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] case-control study indicated that PRP does not significantly improve postoperative pain, potentially due to the high levels of tumor necrosis factor present in conventional PRP preparations. Furthermore, some research has identified body mass index (BMI) and age as critical factors influencing the recovery time of knee joint function. For obese and elderly patients, the beneficial effects of PRP injections following arthroscopic surgery on knee joint function recovery may be restricted.\u003c/p\u003e\u003cp\u003eIn past clinical treatments, our team has summarized several important cautions regarding PRP injections. Prior to PRP administration, it is advisable to conduct an ultrasound or MRI assessment of the knee joint. If joint effusion is detected, it should be aspirated before PRP injection to prevent excessive dilution of the PRP, which could compromise its therapeutic efficacy. In this study, we employed ultrasound-guided PRP injection techniques, allowing for the observation and aspiration of joint effusion to prevent dilution of the PRP concentration during injection. Simultaneously, the position of the meniscus can be accurately identified using ultrasound, allowing for more precise application of platelet-rich plasma (PRP) around the meniscus. The use of leukocyte-poor PRP (LP-PRP) is advocated for intra-articular injection therapy of the knee joint[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Several studies suggest that the administration of leukocyte-rich PRP (LR-PRP) into the joint cavity may provoke synovitis, and the structural benefits post-injection are considerably lower compared to LP-PRP. It is advisable to utilize autologous PRP with a concentration ranging from four to six times for intra-articular injection treatment of the knee joint, with a recommended single injection volume of 4 to 8 ml. The efficacy of PRP in enhancing cell proliferation is positively correlated with its platelet concentration[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Insufficient platelet concentration may result in a negligible reparative effect. PRP should be freshly prepared and administered promptly to preserve its optimal biological activity. If immediate administration is not feasible, PRP should be maintained in a sterile environment and stored at low temperatures to preserve its biological activity and stability. Following a PRP injection, patients may experience varying degrees of joint swelling, increased skin temperature, and exacerbated pain lasting from one to several days. It is advisable for patients to apply local ice packs and limit physical activity for 48 hours to prevent excessive weight-bearing, squatting, stair climbing, and other strenuous activities such as running and jumping. Furthermore, patients with MT in the acute edema phase or those with concurrent bleeding are not recommended to undergo immediate PRP treatment, as the therapeutic effect may be suboptimal and pain may be exacerbated. In such cases, it is preferable to drain the joint effusion and administer corticosteroids to alleviate acute inflammation. PRP treatment should be considered only after the anti-inflammatory effects of corticosteroids have subsided[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, the retrospective design and limited sample size of this study present certain limitations. Additionally, this study focuses on Stoller grade I-II meniscal injuries, and its efficacy for grade III or more severe injuries remains unclear. Future research should involve large-sample, prospective clinical studies with long-term follow-up and high-quality randomized controlled trials to substantiate the efficacy of PRP in treating meniscal injuries.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePlatelet-rich plasma (PRP) therapy significantly attenuates knee pain and improves short-term functional outcomes in patients with Stoller grade I\u0026ndash;II meniscal lesions, implying its capacity to expedite tissue healing. Compared with arthroscopic surgery combined with adjunctive interventions, isolated PRP injection yields equivalent clinical efficacy while conferring superior early functional recovery and accelerated rehabilitation.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data sets generated and analyzed during the current study are not publicly available due to restrictions on ethical approvals involving patient data and anonymity but can be obtained from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective study was approved by the Ethics Committee of the People\u0026apos;s Hospital of Xinjiang Uygur Autonomous Region and carried out by the ethical standards set out in the Helsinki Declaration. Informed consent was received from all participants.\u0026nbsp;Ethical batch number: YK20251013\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding information\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was not funded by any foundation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePCZ and HPL developed the research questions and scope of the study. XM and FA conducted preoperative and postoperative data screening, and data charting. PCZ drafted the manuscript, and prepared tables, and figures with HPL\u0026rsquo;s contribution. XM developed the literature search strategies in collaboration with the other authors. PCZ, HPL, XM, and FA contributed to the organization, analysis, and interpretation of the results. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAdams BG, Houston MN, Cameron KL. The Epidemiology of Meniscus Injury. Sports Med Arthrosc Rev. 2021;29(3):e24\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNazari G. Appraisal of Clinical Practice Guideline: Knee Pain and Mobility Impairments: Meniscal and Articular Cartilage Lesions Revision 2018. J Physiother. 2019;65(1):57.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGopinatth V, Batra AK, Chahla J, Smith MV, Matava MJ, Brophy RH, Knapik DM. Degenerative Meniscus Tears Treated Nonoperatively With Platelet-Rich Plasma Yield Variable Clinical and Imaging Outcomes: A Systematic Review. Arthrosc Sports Med Rehabilitation 2024, 6(2).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEl Zouhbi A, Yammine J, Hemdanieh M, Korbani ET, Nassereddine M. Utility of Platelet-Rich Plasma Therapy in the Management of Meniscus Injuries: A narrative review. Orthop Rev 2024, 16.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSzwedowski D, Jaworski Ł, Szwedowska W, Pękala P, Gagat M. Neovascularization in Meniscus and Tendon Pathology as a Potential Mechanism in Regenerative Therapies: Special Reference to Platelet-Rich Plasma Treatment. Appl Sci 2021, 11(18).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eElphingstone JW, Alston ET, Colorado BS. Platelet-rich plasma for nonoperative management of degenerative meniscal tears: A systematic review. J Orthop. 2024;54:67\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYi X, Lee JE, Lee YH, Yu X, Lee HS. Clinical efficacy of platelet-rich plasma combined with arthroscopic meniscal plasty on pain, function and physiologic indicators in elderly patients with knee meniscus injury: a retrospective observational study. Am J Transl Res. 2023;15(6):3806\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eXie Y, Xing Q, Wang S, Yang Z, Hu A, Wu Q. Can platelet-rich plasma enhance the effect of meniscus repair? A meta-analysis of randomized controlled trials Platelet-rich plasma and meniscus repair. J Orthop Surg 2022, 30(3).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEverhart JS, Cavendish PA, Eikenberry A, Magnussen RA, Kaeding CC, Flanigan DC. Platelet-Rich Plasma Reduces Failure Risk for Isolated Meniscal Repairs but Provides No Benefit for Meniscal Repairs With Anterior Cruciate Ligament Reconstruction. Am J Sports Med. 2019;47(8):1789\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKaminski R, Kulinski K, Kozar-Kaminska K, Wielgus M, Langner M, Wasko MK, Kowalczewski J, Pomianowski S. A Prospective, Randomized, Double-Blind, Parallel-Group, Placebo-Controlled Study Evaluating Meniscal Healing, Clinical Outcomes, and Safety in Patients Undergoing Meniscal Repair of Unstable, Complete Vertical Meniscal Tears (Bucket Handle) Augmented with Platelet-Rich Plasma. Biomed Res Int. 2018;2018:1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKaminski R, Maksymowicz-Wleklik M, Kulinski K, Kozar-Kaminska K, Dabrowska-Thing A, Pomianowski S. Short-Term Outcomes of Percutaneous Trephination with a Platelet Rich Plasma Intrameniscal Injection for the Repair of Degenerative Meniscal Lesions. A Prospective, Randomized, Double-Blind, Parallel-Group, Placebo-Controlled Study. Int J Mol Sci 2019, 20(4).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSakti M, Paturusi IA, Singjie LC, Kusuma SA. The Use of Platelet-Rich Plasma Augmentation in Meniscus Repair Results in a Lower Failure Rate than in the Control Group: A Systematic Review From Meta-analysis. Arthrosc Sports Med Rehabilitation 2024, 6(4).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eXie Y-l, Jiang H, Wang S, Hu A-l, Yang Z-l, Mou Z, Wang Y, Wu Q. Effect of platelet-rich plasma on meniscus repair surgery: A meta-analysis of randomized controlled trials. \u003cem\u003eMedicine\u003c/em\u003e 2022, 101(33).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLi Z, Weng X. Platelet-rich plasma use in meniscus repair treatment: a systematic review and meta-analysis of clinical studies. J Orthop Surg Res 2022, 17(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLisitsyn MP, Atlukhanov RY, Zaremuk AM, Lisitsyna EM. Treatment of horizontal dissection of the knee menisci with platelet-rich plasma (PRP). Literature review and analysis of own data. NN Priorov J Traumatol Orthop. 2021;28(3):21\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlessio-Mazzola M, Felli L, Trentini R, Formica M, Capello AG, Lovisolo S, Maffulli N. Efficacy of Autologous Platelet-Rich Plasma Injections for Grade 3 Symptomatic Degenerative Meniscal Lesions: A 1-Year Follow-up Prospective Study. Sports Health: Multidisciplinary Approach. 2021;14(2):227\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRaju PS, Sriraghavan MR, Jayaraman P, Balasubramaniam B, Karuppiah KS, Kumararaja P. Efficacy of Ultrasound-Guided Injection of Platelet-Rich Plasma in Treatment of Sports-Related Meniscal Injuries. Indian J Radiol Imaging. 2024;35(01):010\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eThirugnana Sambandam S, Dominic D, Ravi P, Jadhav A. Efficacy of Intra-articular Super-dose Platelet-Rich Plasma Injection in Improving Pain in a Middle-Aged Sedentary Female With Meniscal Tear: A Case Report. \u003cem\u003eCureus\u003c/em\u003e 2024.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMedina-Porqueres I, Martin-Garcia P, Sanz-De-Diego S, Gomez-Caceres A, Moya-Torrecilla F, Reyes-Eldblom M, Rosado-Velazquez D. Clinical and Functional Outcome of Meniscal Injuries Treated with Platelet-Rich Plasma: A Single-Center Case Series. Int J Environ Res Public Health 2022, 19(12).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eUtrilla GS, Degano IR, D\u0026rsquo;Ambrosi R. Efficacy of platelet-rich plasma in meniscal repair surgery: a systematic review of randomized controlled trials. J Orthop Traumatol 2024, 25(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLo Presti M, Costa GG, Agr\u0026ograve; G, Vasco C, Boffa A, Di Martino A, Andriolo L, Cenacchi A, Zaffagnini S, Filardo G. Platelet-Rich Plasma Injections Do Not Improve the Recovery After Arthroscopic Partial Meniscectomy: A Double-Blind Randomized Controlled Trial. Am J Sports Med. 2024;52(13):3198\u0026ndash;205.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYang C-P, Hung K-T, Weng C-J, Chen AC-Y, Hsu K-Y, Chan Y-S. Clinical Outcomes of Meniscus Repair with or without Multiple Intra-Articular Injections of Platelet Rich Plasma after Surgery. J Clin Med 2021, 10(12).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWeldon M, Lowe WR, Lauck K, Kleihege J, Warth RJ, Syed M, Pontes AC, Hayes M, Bailey LB. Does Intra-operative PRP Improve Patient Function \u0026amp; Complication Rates Following ACL Reconstruction With Meniscus Repair? Orthop J Sports Med 2020, 8(3_suppl2).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMedina-Porqueres I, Martin-Garcia P, Sanz-De-Diego S, Gomez-Caceres A, Moya-Torrecilla F, Reyes-Eldblom M, Rosado-Velazquez D. Clinical and Functional Outcome of Meniscal Injuries Treated with Platelet-Rich Plasma: A Single-Center Case Series. Int J Environ Res Public Health 2022, 19(12).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhang H, Chen S, Qiu M, Zhou A, Yan W, Zhang J. Lateral meniscus allograft transplantation with platelet-rich plasma injections: A minimum two-year follow-up study. Knee. 2018;25(4):568\u0026ndash;76.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Platelet-rich plasma, Arthroscopy, Meniscus Tear, Clinical Efficacy","lastPublishedDoi":"10.21203/rs.3.rs-8077279/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8077279/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eTo optimize patient treatment plans, this study compares the early clinical outcomes of PRP injection alone versus arthroscopic surgery combined with PRP for Stoller I-II meniscus tears, analyzing the pros and cons of each treatment and recovery status, and recommends the best clinical strategy based on the severity of the injury.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA retrospective study was conducted on patients with Stoller I-II meniscus injuries at the People's Hospital of Xinjiang Uygur Autonomous Region from September 2023 to December 2024. Patients with knee osteoarthritis, cruciate ligament injuries, or other knee issues were excluded. Participants were divided into two treatment groups: PRP injection alone and arthroscopic repair with PRP injection. Efficacy was assessed using the Visual Analog Scale (VAS), Lysholm score, and Japanese Orthopedic Association (JOA) criteria before treatment and at 1, 3, and 6 months post-treatment. Additionally, MRI examinations of the knee joint were performed at the final follow-up to facilitate radiological assessment. Data analysis was performed using SPSS 22.0, employing the Chi-square test for categorical data and repeated measures ANOVA for within-group comparisons over time. Comparisons between the two groups were performed using independent samples t-tests.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eA total of 40 patients were enrolled in the study, with 20 patients allocated to each group. No serious complications were observed in either group following treatment. Compared with pre-treatment, the VAS scores of both groups significantly decreased (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) at 1, 3, and 6 months after treatment, while the Lysholm and JOA scores significantly increased (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), with statistically significant differences. Furthermore, radiological analysis demonstrated evidence of improvement in MRI images for both groups at the final follow-up when compared to pre-treatment images.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003ePlatelet-rich plasma (PRP) therapy has been demonstrated to effectively alleviate knee joint pain associated with Stoller grade I-II meniscus tears in the short term, while also enhancing knee joint function. This treatment exhibits promising early efficacy in facilitating meniscus repair. Notably, when compared to arthroscopic surgery combined with PRP, PRP injection alone yields comparable therapeutic outcomes to surgical intervention.\u003c/p\u003e","manuscriptTitle":"Comparative Efficacy of Platelet-Rich Plasma Injection Alone Versus Arthroscopy Combined with Platelet-Rich Plasma Injection in the Treatment of Stoller Grade I-II Meniscus Tear","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-08 07:01:34","doi":"10.21203/rs.3.rs-8077279/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-16T08:08:26+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-14T23:55:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-14T14:20:24+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-14T09:24:59+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-12T13:11:14+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-09T20:07:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"224812938766276472029653843674401855072","date":"2025-12-09T16:54:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"304255181535403516168408576954923639607","date":"2025-12-08T16:47:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"197604093382753773863109830432221160284","date":"2025-12-08T13:00:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"305819485543513992360840666513220656062","date":"2025-12-08T00:59:55+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-07T11:59:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"287898531309458363293328959036533359661","date":"2025-12-03T21:00:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"208697539855996357497519154052747412428","date":"2025-12-03T13:29:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"72063828245924126645887430896461158708","date":"2025-12-03T08:13:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"268522767687560507135173812724555361682","date":"2025-12-02T22:11:43+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-02T16:55:37+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-23T14:06:41+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-23T14:04:13+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-23T10:41:44+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Musculoskeletal Disorders","date":"2025-11-19T12:37:19+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"564fd0d2-7643-4132-ac95-79279d82e63e","owner":[],"postedDate":"December 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-22T09:38:23+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-08 07:01:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8077279","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8077279","identity":"rs-8077279","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}