Saved0Subscribe
SportsMeta-analysis

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

Arthroscopy The Journal of Arthroscopic and Related Surgery · 5 Oct 2026

Rigour55/100
Clinical45/100
Impact†49/100

† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.

Why it matters

Orthobiologics are often marketed to patients as a way to speed ACL graft healing, but the current randomised evidence does not show better function or tunnel healing at about 1 to 2 years.

The evidence

This systematic review pooled 9 randomised trials (543 patients) comparing ACL reconstruction with versus without orthobiologic augmentation: platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC), or mesenchymal stem cells applied to the graft or tunnels. Pooled analyses found no significant difference in Lysholm scores with PRP (reported SMD 0.99, 95% CI 0.72 to 1.36, P = .95), in KOOS with BMAC (P = .45), or in femoral tunnel widening with PRP (P = .35). Only a few individual trials showed isolated imaging benefits, and no orthobiologic-related complications were reported. Each pooled analysis included only 3 small, heterogeneous trials.

Lysholm score: Smd 0.99 (95% CI 0.72 to 1.36; Lysholm). The interval favours the first group; the size of the benefit needs clinical interpretation.

Why this rigour score?

Meta-analysis of RCTsDesign starting point: 60.8

55/ 100

Raised the score

  • Prospectively registered+5.1
  • Pools randomised trials+5.1

Lowered the score

    No negative adjustments recorded.

    Score capped at 55. The conclusion asserts a benefit the primary outcome did not show.

    Methods at a glance

    Recorded assessment
    • Comprehensive literature searchMet
    • Risk of bias assessedMet
    • Bias considered in synthesisMet
    • Publication bias assessedNot met
    • Study exclusions justifiedNot met
    • Prospective registrationMet

    Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.

    See the full score breakdown
    Study design starting point
    60.8
    Prospectively registered
    +5.1
    Pools randomised trials
    +5.1
    Comprehensive literature search
    +3.4
    Risk of bias assessed in the included studies
    +3.4
    Risk of bias carried into the synthesis
    +2.5
    Methodological cap
    −25.3
    Final rigour score rounded
    55 / 100

    Study design sets the starting point and a ceiling of 96. Recorded methods then adjust the score. Points are shown to one decimal place; the final score uses unrounded values.

    Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.

    For journal club

    1.How would you counsel a young athlete who asks to pay out of pocket for PRP or BMAC during ACL reconstruction to return to sport faster?

    2.Should a reported early MRI graft signal difference (such as with BMAC at 3 months) change rehabilitation or return-to-sport timing if patient-reported outcomes are unchanged at final follow-up?

    Original publication title

    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

    Read original paper