Autologous platelet concentrate augmentation in anterior cruciate ligament reconstruction : a level I evidence-based meta-analysis

Abstract

Introduction

Anterior cruciate ligament (ACL) injuries are common in young active individuals and reconstruction remains the standard treatment. Recently, biological augmentation with autologous platelet concentrates (APC) has gained interest given the potential to enhance graft healing. This meta-analysis examined whether the use of APC improves patient-reported outcome measures (PROM) and reduces complications after ACL reconstruction. Methods

Randomized controlled trials (RCT) comparing standard ACL reconstruction with APC-augmented procedures were included. Eligible articles were peer-reviewed and published in English, German, Italian, French or Spanish. A systematic search of PubMed, Web of Science and Embase was performed in June 2025. Extracted data included demographics, follow-up and PROMs. Methodological quality was assessed using the Cochrane RoB2 tool. Meta-analyses were conducted with Review Manager 5.3, applying inverse variance and Mantel-Haenszel methods. A subgroup analysis was performed for platelet-rich plasma (PRP). Results

A total of 14 RCTs comprising 869 patients met the inclusion criteria. Methodological quality was acceptable, with no study rated as having a high risk of bias. The mean follow-up was 12.2 ± 7.4 months. Baseline features and PROMs were comparable between groups. The use of APC augmentation significantly reduced anterior tibial laxity but the effect size was below the clinical threshold. No significant differences were observed in PROMs or revision rates. Conclusion

The current level of I evidence does not support APC augmentation as a means to improve short-term outcomes or reduce complications after ACL reconstruction; however, its safety profile and biological rationale justify further high-quality RCTs with standardized protocols and longer follow-up.