{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T15:56:01Z","timestamp":1791215761814,"version":"4.1.0"},"reference-count":31,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["arthroscopyjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthroscopy"],"abstract":"\n Purpose<\/jats:title>\n To review current randomized controlled trials (RCTs) investigating the efficacy of orthobiologic augmentation for anterior cruciate ligament reconstruction (ACLR) for clinical or radiographic outcomes.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n PubMed, EMBASE, and the Web of Science databases were queried in accordance with the Preferred Reporting Items for Systematic reviews and Meta\u2010Analyses guidelines to identify RCTs investigating the efficacy of orthobiologics for ACLR. Studies were included if they compared patient\u2010reported outcome measures or radiographic evaluation of graft maturation of ACLR with and without orthobiologics. Included forms of orthobiologics were platelet\u2010rich 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\u2010reported outcome measures or radiographic evaluation of graft maturation. For outcome measures with 3 or more studies that used the same orthobiologic, meta\u2010analyses were conducted using DerSimonian\u2010Laird random\u2010effects models, reported in standardized mean difference (SMD).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n There were 9 RCTs with 543 total patients investigating platelet\u2010rich plasma (5 studies), bone marrow aspirate concentrate (3 studies), and mesenchymal stem cell (1 study) augmentation in ACLR. Meta\u2010analysis revealed no significant difference in Lysholm scores (SMD\u2009=\u20090.99 [0.72\u20101.36],\n I<\/jats:italic>\n 2<\/jats:sup>\n \u2009=\u20090.58%,\n P<\/jats:italic>\n \u2009=\u2009.95) with versus without platelet\u2010rich 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\u2009=\u20090.78 [0.41\u20101.49],\n I<\/jats:italic>\n 2<\/jats:sup>\n \u2009=\u200976.97%,\n P<\/jats:italic>\n \u2009=\u2009.45). Orthobiologic augmentation was not found to decrease bone tunnel enlargement (SMD\u2009=\u20091.56 [0.61\u20103.96],\n I<\/jats:italic>\n 2<\/jats:sup>\n \u2009=\u200987.46%,\n P<\/jats:italic>\n \u2009=\u2009.35). 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.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Orthobiologic augmentation for ACLR shows similar patient\u2010reported 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.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence<\/jats:title>\n Level II, systematic review and meta\u2010analysis of Level I and II randomized controlled trials.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/arj.70638","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T15:30:01Z","timestamp":1791214201000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Orthobiologic Augmentation for Anterior Cruciate Ligament Reconstruction Is Not Associated With Improved Clinical or Radiographic Outcomes: A Systematic Review and Meta\u2010analysis of Randomized Controlled Trials"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4669-0097","authenticated-orcid":false,"given":"Alexis","family":"Driscoll","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery Tufts Medical Center Boston Massachusetts U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Mazzocco","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Tufts Medical Center Boston Massachusetts U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Fucaloro","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Boston Medical Center Boston Massachusetts U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5370-3864","authenticated-orcid":false,"given":"Charley","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Tufts Medical Center Boston Massachusetts U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2493-5375","authenticated-orcid":false,"given":"Jack","family":"Bragg","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Tufts Medical Center Boston Massachusetts U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Puzzitiello","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Tufts Medical Center Boston Massachusetts U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9928-0879","authenticated-orcid":false,"given":"Matthew J.","family":"Salzler","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Tufts Medical Center Boston Massachusetts U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,5]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"crossref","first-page":"1912","DOI":"10.1016\/j.arthro.2024.08.018","article-title":"Decreasing incidence of anterior cruciate ligament tears and increasing utilization of anterior cruciate ligament reconstruction in the United States from 2010 to 2020","volume":"41","author":"Bergstein VE","year":"2025","journal-title":"Arthroscopy."},{"key":"e_1_2_7_3_1","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1016\/j.csm.2007.06.007","article-title":"Biology of autograft and allograft healing in anterior cruciate ligament reconstruction","volume":"26","author":"Gulotta LV","year":"2007","journal-title":"Clin Sports Med."},{"key":"e_1_2_7_4_1","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.csm.2018.08.003","article-title":"Ortho\u2010biologics for ligament repair and reconstruction","volume":"38","author":"Chahla J","year":"2019","journal-title":"Clin Sports Med."},{"key":"e_1_2_7_5_1","doi-asserted-by":"crossref","first-page":"6959","DOI":"10.3390\/jcm14196959","article-title":"Biologic augmentation in anterior cruciate ligament reconstruction and beyond: A review of PRP and BMAC","volume":"14","author":"Pham GM","year":"2025","journal-title":"J Clin Med."},{"key":"e_1_2_7_6_1","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1080\/09537104.2021.1902969","article-title":"The efficacy of platelet rich plasma on anterior cruciate ligament reconstruction: A systematic review and meta\u2010analysis","volume":"33","author":"Lv ZT","year":"2022","journal-title":"Platelets."},{"key":"e_1_2_7_7_1","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1002\/ksa.12127","article-title":"Platelet\u2010rich plasma augmentation in anterior cruciate ligament reconstruction: Evidence is still too scattered. A scoping review of randomised controlled trials","volume":"32","author":"Delcogliano M","year":"2024","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"key":"e_1_2_7_8_1","doi-asserted-by":"crossref","first-page":"2265","DOI":"10.1016\/j.arthro.2022.03.016","article-title":"Editorial commentary: Bone marrow aspirate concentrate may accelerate anterior cruciate ligament allograft using bone patellar tendon bone maturation on magnetic resonance imaging, but clinical differences have not been demonstrated","volume":"38","author":"Sheean AJ","year":"2022","journal-title":"Arthroscopy."},{"key":"e_1_2_7_9_1","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page MJ","year":"2021","journal-title":"BMJ."},{"key":"e_1_2_7_10_1","doi-asserted-by":"crossref","first-page":"2501","DOI":"10.1177\/0363546518803365","article-title":"Timeline for maximal subjective outcome improvement after anterior cruciate ligament reconstruction","volume":"47","author":"Agarwalla A","year":"2019","journal-title":"Am J Sports Med."},{"key":"e_1_2_7_11_1","doi-asserted-by":"crossref","first-page":"3781","DOI":"10.1002\/ksa.12626","article-title":"The recovery trajectory of anterior cruciate ligament ruptures in randomised controlled trials: A systematic review and meta\u2010analysis of operative and nonoperative treatments","volume":"33","author":"Ridha A","year":"2025","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"key":"e_1_2_7_12_1","doi-asserted-by":"crossref","first-page":"1624","DOI":"10.1177\/21925682221110527","article-title":"Fixed\u2010effect vs random\u2010effects models for meta\u2010analysis: 3 points to consider","volume":"12","author":"Dettori JR","year":"2022","journal-title":"Global Spine J."},{"key":"e_1_2_7_13_1","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1002\/sim.1186","article-title":"Quantifying heterogeneity in a meta\u2010analysis","volume":"21","author":"Higgins JP","year":"2002","journal-title":"Stat Med."},{"key":"e_1_2_7_14_1","doi-asserted-by":"crossref","first-page":"e081123","DOI":"10.1136\/bmj-2024-081123","article-title":"CONSORT 2025 statement: Updated guideline for reporting randomised trials","volume":"389","author":"Hopewell S","year":"2025","journal-title":"BMJ."},{"key":"e_1_2_7_15_1","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1177\/001316446002000104","article-title":"A coefficient of agreement for nominal scales","volume":"20","author":"Cohen J","year":"1960","journal-title":"Edu Psychol Meas."},{"key":"e_1_2_7_16_1","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: A revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne JAC","year":"2019","journal-title":"BMJ."},{"key":"e_1_2_7_17_1","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1007\/s43465-021-00533-z","article-title":"Clinical use of platelet\u2010rich plasma to promote tendon\u2010bone healing and graft maturation in anterior cruciate ligament reconstruction\u2013A randomized controlled study","volume":"56","author":"Gong H","year":"2022","journal-title":"Indian J Orthop."},{"key":"e_1_2_7_18_1","doi-asserted-by":"crossref","first-page":"1206","DOI":"10.1016\/j.arthro.2009.06.002","article-title":"Has platelet\u2010rich plasma any role in anterior cruciate ligament allograft healing?","volume":"25","author":"Nin JR","year":"2009","journal-title":"Arthroscopy."},{"key":"e_1_2_7_19_1","doi-asserted-by":"crossref","first-page":"789317","DOI":"10.1155\/2014\/789317","article-title":"The potentially positive role of PRPs in preventing femoral tunnel widening in ACL reconstruction surgery using hamstrings: A clinical study in 51 patients","volume":"2014","author":"Starantzis KA","year":"2014","journal-title":"J Sports Med."},{"key":"e_1_2_7_20_1","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1007\/s00167-012-1980-z","article-title":"Platelet\u2010rich plasma: Does it help reduce tunnel widening after ACL reconstruction?","volume":"21","author":"Vadala A","year":"2013","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"key":"e_1_2_7_21_1","doi-asserted-by":"crossref","first-page":"S36","DOI":"10.1016\/S0020-1383(14)70008-7","article-title":"Comparison between 2 different platelet\u2010rich plasma preparations and control applied during anterior cruciate ligament reconstruction. 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