Surgical augmentation techniques to improve meniscus tear healing in anterior cruciate ligament intact knees: A systematic review

IMPORTANCE: Studies remain divided on the use of surgical augmentation techniques (SATs) to optimize outcomes after isolated meniscal repair. AIM OR OBJECTIVE: The aim of this study was to analyze the revision rates, clinical outcomes, and the advantages and disadvantages of SATs for isolated meniscal repairs. The hypothesis was that SATs would improve the results of meniscal repair in anterior cruciate ligament (ACL)-intact knees. EVIDENCE REVIEW: A systematic review using the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines was conducted. PubMed, Cochrane, and EMBASE databases were queried in June 2025 for publications on isolated meniscal repair with SATs; SATs included marrow stimulation, rasping, and trephination. Study design, patient demographics, characteristics of the meniscal tear, surgical technique, type of SAT, postoperative rehabilitation protocols, outcome measures, follow-up duration, and any advantages or disadvantages of the SAT were recorded, reviewed, and analyzed by two independent reviewers. Studies were assessed for quality and risk of bias by two appraisal tools. FINDINGS: Of 2364 articles screened, 12 met the inclusion criteria, for a total of 387 patients who underwent SAT to enhance meniscal tear healing in ACL-intact knees. Among these, 50% (6/12) used marrow stimulation, 42% (5/12) rasping, and 17% (2/12) trephination. In one study, rasping was combined with marrow stimulation. There was one randomized controlled trial and six studies with a control group. Revision rates were reported in seven studies and ranged from 0% to 48%. One study found that marrow stimulation was beneficial over standard repair techniques. Three studies reported better functional outcomes with augmented repair than with standard repair, while two found no difference. No major adverse events were reported. There was marked heterogeneity in surgical methods for the three SAT approaches and in post-operative rehabilitation protocols. CONCLUSION AND RELEVANCE: Isolated meniscal repair with SATs appears to be simple, safe, and time-efficient, without any adverse impact on outcomes and with no identified contraindications, supporting its use in clinical practice. Further randomized controlled trials are required to confirm the efficacy of the various techniques and to determine whether one technique is superior to another. LEVEL OF EVIDENCE: III.