Orthobiologic Augmentation for Anterior Cruciate Ligament Reconstruction Is Not Associated With Improved Clinical or Radiographic Outcomes: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Authors

Alexis Driscoll, John Mazzocco, Stephen Fucaloro, Charley Sun, Jack Bragg, Richard Puzzitiello, Matthew J Salzler

Published in

Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. Oct 05, 2026. Epub Oct 05, 2026.

Abstract

To review current randomized controlled trials (RCTs) investigating the efficacy of orthobiologic augmentation for anterior cruciate ligament reconstruction (ACLR) for clinical or radiographic outcomes.
PubMed, EMBASE, and the Web of Science databases were queried in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines to identify RCTs investigating the efficacy of orthobiologics for ACLR. Studies were included if they compared patient-reported outcome measures or radiographic evaluation of graft maturation of ACLR with and without orthobiologics. Included forms of orthobiologics were platelet-rich plasma, bone marrow aspirate concentrate, and mesenchymal stem cell. Studies were excluded if they applied the orthobiologic to the harvest or donor site, rather than the ACL graft itself, or if they did not report patient-reported outcome measures or radiographic evaluation of graft maturation. For outcome measures with 3 or more studies that used the same orthobiologic, meta-analyses were conducted using DerSimonian-Laird random-effects models, reported in standardized mean difference (SMD).
There were 9 RCTs with 543 total patients investigating platelet-rich plasma (5 studies), bone marrow aspirate concentrate (3 studies), and mesenchymal stem cell (1 study) augmentation in ACLR. Meta-analysis revealed no significant difference in Lysholm scores (SMD = 0.99 [0.72-1.36], I² = 0.58%, P = .95) with versus without platelet-rich plasma augmentation for ACLR. Similar knee injury and osteoarthritis outcome scores were found for ACLR augmented by bone marrow aspirate concentrate versus ACLR alone (SMD = 0.78 [0.41-1.49], I² = 76.97%, P = .45). Orthobiologic augmentation was not found to decrease bone tunnel enlargement (SMD = 1.56 [0.61-3.96], I² = 87.46%, P = .35). All studies reported a radiographic evaluation of graft maturation, 6 of which reported no significant change with orthobiologic augmentation. No complications related to orthobiologics were reported.
Orthobiologic augmentation for ACLR shows similar patient-reported outcome measures and bone tunnel healing as compared with ACLR alone, although these results are limited by heterogeneity. This review suggests limited efficacy regarding orthobiologic augmentation for ACLR.
Level II, systematic review and meta-analysis of Level I and II randomized controlled trials.

PMID:
42832231
Bibliographic data and abstract were imported from PubMed on 06 Oct 2026.

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