Abstract
PURPOSE: Meniscal tears are common knee injuries that often require surgical repair due to pain and mechanical symptoms. Limited vascularisation in specific meniscal regions hinders healing, encouraging the use of fibrin clots as a biological augmentation strategy. This study aims to critically evaluate the available evidence on the use of fibrin clot as a biological adjunct in meniscal repair with sutures and its potential impact on healing outcomes. METHODS: A systematic review was conducted following the PRISMA guidelines, encompassing the PubMed, Embase and Scopus databases up to April 2025. Studies investigating meniscal repair augmented with a fibrin clot were included in the analysis. Data extracted included study design, type of meniscal lesion, surgical technique, clot preparation and failure rates. RESULTS: Eleven studies were included, comprising both retrospective case series and limited comparative studies. Most studies involved small sample sizes and heterogeneous populations, characterised by diverse meniscal tear patterns, surgical techniques and clot sources. Reported healing rates ranged from 43% to above 90%, but outcome definitions were inconsistent. A critical risk of bias was identified in most of the studies. CONCLUSIONS: The current evidence on the use of fibrin clot as an adjunct to meniscal repair is limited and inconsistent. Although some studies suggest potential benefits, the overall quality of evidence is low. Further high-quality randomised controlled trials are needed to determine whether fibrin clot improves meniscal healing outcomes. LEVEL OF EVIDENCE: Level IV, systematic review. CLINICAL TRAIL REGISTRATION: This systematic review was registered in PROSPERO (registration number: CRD42024614021).