ABSTRACT: Meniscal tears are among the most common injuries in the knee, and partial as well as total meniscectomy has been advocated as the treatment for meniscal injury. Over the years, the role of the meniscus as a shock absorber, load transmitter, and secondary anterior stabilizer, along with its proprioceptive and lubrication role, has been well established, and meniscal repair is recommended, especially in younger individuals. Factors such as tear location, pattern, chronicity, size, and extent; repair technique; and patient age and habits can influence meniscal repair, and to enhance meniscal healing, a variety of augmentation techniques have been introduced. These include needling, trephination, synovial abrasion, and the use of adjuvants such as platelet-rich plasma, platelet clots, fibrin clots, bone marrow clots, and stem cells. A second-generation platelet derivative called “platelet-rich fibrin” (PRF) has predictable platelet, growth factor, and cell mediator concentrations without using any anticoagulants. We describe a reproducible and simple way to harvest PRF and create and use a PRF clot, along with detailed instructions on how to integrate the clot with a meniscal repair arthroscopically. Technique Video Video 1 After positioning and draping, diagnostic arthroscopy is performed, and a longitudinal tear is noted on the posterior horn of the medial meniscus in the red-white zone. The tear edges are freshened and debrided, followed by trephination to create blood channels. The decision to perform platelet-rich fibrin (PRF) clot augmentation is made, and 20 mL of blood is drawn and transferred to 2 tubes, each with a capacity of 10 mL. The tubes are placed into a conventional centrifugation machine at 3,000 rpm for a period of 12 minutes. A settling time of up to 5 minutes is ideal for the clot to become consolidated. The clot is taken out of the glass tube in a sterile fashion using a straight artery forceps. The clot is then trimmed just below the white clot–red clot junction to retain the maximum concentration of platelets. Gauze is used to remove the platelet-poor plasma. By use of a suture retriever, the clot is introduced into the joint and positioned between the meniscal tear edges. The clot can be manipulated and further positioned appropriately using the elbow of the arthroscopic probe. Once the clot is positioned properly, all-inside sutures are placed and tightened with the clot sandwiched between the tear edges. The sutures are then cut after final tightening. For rotator cuff repair in the shoulder, a similar technique can be used. First, the medial-row anchors are placed; then, the PRF clot is introduced using a suture retriever and tucked under the cuff at the cuff-bone interface. Once the clot is positioned, the lateral-row anchors can be placed, securing the clot in place.
