Bone Marrow Aspirate Concentrate Injection Research Articles

Treatment of osteoarthritis knee with bone marrow aspirate concentrate injection

To assess the clinical effectiveness and safety of bone marrow aspirate concentrate (BMAC) injections given intraarticularly as a potential treatment for knee osteoarthritis (OA). Data from 60 patients with knee osteoarthritis treated with BMAC injection at a single centre between December 2021 and December 2022 were retrospectively examined. We only included patients with idiopathic osteoarthritis. Post-traumatic osteoarthritis, prior knee surgery, ageless then 50 years or over 85 years, an active infection, uncontrolled diabetes mellitus, rheumatological or another systemic condition, cancer, or immunosuppressive medication use were all exclusion factors. A single-spin manual approach was used to aspirate and concentrate bone marrow from the iliac crest. The Numeric pain scale (NPS) and Oxford knee score (OKS) were used to evaluate patients both before and after the treatment. A 12-month follow-up period was used. The statistical analysis comprised a total of 60 patients. With a mean age of 67 years (range 50-85), there were 42 females and 18 males. At the end of the follow-up period, the mean NPS reduced from 8.12 to 4.31 (p< 0.001) and the mean OKS rise from 22.30 to 34.74 (p <0.001). There were no problems. A single BMAC intra-articular injection is a dependable and safe technique that improves the clinical condition of knee OA.

Intra-articular injection of bone marrow aspirate concentrate (mesenchymal stem cells) in KL grade III and IV knee osteoarthritis: 4 year results of 37 knees

Cell based therapies are increasingly used and results of bone marrow aspirate concentrate (BMAC) show encouraging short- to middle term results, superior to hyaluronic acid and platelet rich plasma (PRP). Most studies describe patients with mild to moderate arthritis and results of patients with KL III and IV osteoarthritis of the knee are limited to short term evaluations. Hence, the aim of this prospective study was to investigate the mid-term outcome of BMAC injections in patients with severe osteoarthritis of the knee. The BMAC was retrieved from the iliac crest as previously published with the “reorientation technique” from the iliac crest in supine position in analgosedation and injected into the patients’ osteoarthritic knees. Patients were followed-up for 4 years. WOMAC, IKDC, SF 36 and walking distance were measured in a total of 37 participants. There was an improvement of IKDC and WOMAC from the first year onwards and a significant improvement beginning from year 2 up to the mid-term follow-up: IKDC increased significantly from 56 ± 12 (range 34–81) to 73 ± 13 (range 45–100), p < 0.001. WOMAC decreased significantly from 40 ± 23 (range 6–96) to 18 ± 18 (range 0–67), p < 0.001. 35 of 37 knees improved regarding IKDC and WOMAC score from the first to the last follow-up. Not a single protheses had to be implanted. Elaborate statistical analysis was done to exclude covariates and confounders (age, time, BMI,…). In summary, this is the first study on BMAC injections into 37 osteoarthritic knees with a 4-year follow up showing significant improvements in IKDC and WOMAC scores, and with a 95% success rate and significant improvement in walking distance.Clinical relevance Describes the 4-year outcome of BMAC injections for knees with severe osteoarthritis.

The Combined Intraosseous Administration of Orthobiologics Outperformed Isolated Intra-articular Injections in Alleviating Pain and Cartilage Degeneration in a Rat Model of MIA-Induced Knee Osteoarthritis

Background: Intra-articular (IA) platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMAC) injections have shown efficacy and safety in treating osteoarthritis (OA). However, the effectiveness and mechanisms of combined intraosseous (IO) administration of these orthobiologics have yet to be explored. Purpose/Hypothesis: The purpose of this study was to evaluate the effect on pain, cartilage, synovium/infrapatellar fat pad (IFP), and subchondral bone in rat knee OA, comparing isolated IA with combined IA and IO (IA+IO) injections of PRP or BMAC. It was hypothesized that combined injections would be superior to sole IA injections. Study Design: Controlled laboratory study. Methods: A total of 48 rats were divided into 6 groups: sham (only joint puncture during OA induction with IA+IO saline injection treatment) and 5 groups with OA induction, control (IA+IO saline injection), PRP (IA PRP+IO saline injection), BMAC IA (IA BMAC+IO saline injection), PRP IA+IO (IA+IO PRP injection), and BMAC IA+IO (IA+IO BMAC injection). OA was induced by IA injection of monosodium iodoacetate (MIA). Rats were administered different orthobiologics according to their grouping 3 weeks after the MIA injection. Pain changes were evaluated using the weightbearing ratio assay at weeks 3, 4, 5, 7, and 9 after OA induction. Rats were euthanized at week 9 for gross, radiological, histological, immunohistochemical, and immunofluorescence assessments of cartilage, synovium, and subchondral bone. Results: Compared with the control group, all orthobiologics injection groups had reduced joint pain. Compared with IA injection, IA+IO injections provided superior pain relief by suppressing calcitonin gene-related peptide and substance P in both the synovium/IFP and subchondral bone. IA+IO injections slowed the progression of subchondral bone lesions by inhibiting CD31hiEmcnhi vessel formation and excessive osteoclast and osteoblast turnover while preserving subchondral bone microarchitecture, slowing cartilage degeneration. However, IA+IO injections did not outperform isolated IA injections in reducing synovitis and synovium/IFP fibrosis. Compared with PRP, BMAC exhibited superior inhibition of pain-related mediators, but no significant differences were observed in synovitis suppression, infrapatellar fat pad fibrosis, and subchondral bone protection. Conclusion: IA+IO injections of orthobiologics were more effective in relieving pain, slowing cartilage degeneration, and inhibiting abnormal vascularization and remodeling compared with isolated IA injections. BMAC showed superior pain relief in the synovium/IFP and subchondral bone compared with PRP. Further research is needed to optimize PRP and BMAC components for enhanced efficacy in OA management. Clinical Relevance: Our findings contribute to advancing the understanding of pain relief mechanisms and support the endorsement of IO injection of orthobiologics for the treatment of OA and joint pain.

BMAC Injection Improves 65-Year Old’s Knee Osteoarthritis Pain

This case study presents the challenging scenario of a 65-year-old male who suffered from debilitating knee pain resulting from preexisting arthritis. Despite various attempts to alleviate the pain, including a corticosteroid injection and activity modification, the patient’s condition continued to deteriorate, leading to limited mobility and reliance on a cane to ambulate. With the failure of conservative measures, the patient’s orthopedic surgeon contemplated the possibility of a total knee replacement. However, the patient opted for an alternative treatment plan involving bone marrow aspirate concentrate (BMAC) injections. After an initial left knee aspiration, two injections of BMAC were administered. Remarkably, three weeks after the first injection, the patient’s condition improved by 90%, and the pain during physical activities reduced significantly. At the patient’s final appointment, he reported being able to walk up and down the stairs without pain. Four months after treatment, the patient embarked on a journey to the Swiss Alps where he spent upwards of four hours a day climbing in the mountainous terrain. He expressed a total absence of pain while navigating up and down the steep landscape. This case study highlights the potential efficacy of BMAC injections as a non-surgical treatment option for knee osteoarthritis pain management. Further research is necessary to evaluate long-term outcomes of this treatment approach.

Bone marrow aspirate concentrate – A novel approach to alter the course of temporomandibular joint osteoarthritis (a clinical study)

IntroductionTMJ OA is characterized by severe osteocartilaginous degradation of the joint structure resulting in severe deterioration of both joint function as well as joint structure. bone marrow aspirate concentrate (BMAC) gained wide acceptance as an auspicious addition for regenerative medicine as it is confirmed to be a rich source of pluripotent mesenchymal stem cells and growth factors that produce promising relief of clinical symptoms with significant repair of the joint structure. Thus, the study aims at assessing the efficacy of bone marrow aspirate concentrate (BMAC) as a treatment modality for TMJ osteoarthritis and compare its efficacy with that of hyaluronic acid (HA). Methods24 patients were included in the present study and divided into 12 patients in each group. Joint arthrocentesis was performed to all patients followed by intra-articular BMAC injection in Group I. While Group II received HA acid injection ResultsA trend towards long term joint repair at 12 and 18 months follow up period was observed in the bone marrow aspirate concentrate (BMAC) group as a therapeutic modality for TMJ OA by providing necessary growth factors and anti-inflammatories that impedes the progression of the osteoarthritic degeneration. On the contrary to the viscosupplementary action of hyaluronic acid (HA) that showed relapse of patients conditions. ConclusionBone marrow aspirate concentrate (BMAC) is able to reverse the degenerative effects of TMJ OA however,further studies are mandatory with larger population and longer follow-up time.

Derivation of a clinical decision rule for a bone marrow aspirate concentrate injection in knee osteoarthritis.

Aim: To develop a simple clinical decision rule (CDR) to identify people with knee osteoarthritis who are likely or unlikely to benefit from bone marrow aspirate concentrate (BMAC) injection. Materials & methods: A total of 92 people with clinical and radiographic evidence of refractory knee osteoarthritis received a single intra-articular (IA) BMAC injection. Multiple logistic regression analysis was used to determine which combination of risk factors predicted BMAC responsiveness. A responder was defined as a person whose knee pain improved more than 15% from baseline 6months postprocedure. Results: The CDR demonstrated that those with lower pain levels, or high pain levels with previous surgery, could be predicted to benefit from a single IA BMAC injection. Conclusion: A simple CDR containing three variables predicted responsiveness to a single IA knee BMAC injection with high accuracy. Further validation of the CDR is required prior to routine use in clinical practice.

Intra-articular injection of bone marrow aspirate concentrate (BMAC) or adipose-derived stem cells (ADSCs) for knee osteoarthritis: a prospective comparative clinical trial

BackgroundWe determined whether autologous mesenchymal stem cells (MSCs) injections provide clinical and functional improvements in knee osteoarthritis (KOA) patients, and whether the results differ between autologous bone marrow cells (BMAC) and adipose-derived stromal cells (ADSCs).MethodsBetween January 2021 and April 2022, 51 patients undergoing intra-articular injection of BMAC and 51 patients undergoing intra-articular injection of ADSCs were prospectively recruited. The Kellgren and Lawrence (K–L) classification was used to grade the severity of osteoarthritis. Knee Injury and Osteoarthritis Outcome Score (KOOS), Oxford Knee Score (OKS), and visual analog scale (VAS) were collected for all 102 patients in the previous week before the procedures, and at the one and 6 months from injection.ResultsKnee KOOS scores, knee OKS scores, and VAS pain scores changed in similar ways in the two treatment groups. Both treatment groups demonstrated significant improvement pre-procedure to post-procedure in knee KOOS scores (p < 0.0001), knee OKS scores (p < 0.0001), and VAS pain scores (p < 0.0001). Patients with K–L grade 2 showed better functional and clinical outcomes than patients with K–L grades 3 and 4 (p < 0.0001).ConclusionBoth intra-articular BMAC and ADSC injections significantly improved pain and functional outcomes at 6-month follow-up in patients with KOA. The difference between BMAC and ADCSs groups as tissue sources of MSCs was not statistically significant in terms of clinical and functional outcomes.

Comparative evaluation of the effectiveness of autological bone marrow aspirate concentrate and platelete-rich plasma injected intraosseously in the treatment of the knee osteoarthritis

The aim of the study was a comparative evaluation of bone marrow aspirate concentrate (BMAC) and platelet-rich plasma (PRP), administered intraosseously to patients with stage IIIII knee osteoarthritis (OA) according to the Kellgren Lawrence (K-L) classification. Materials and methods: 40 patients were recruited and divided into 2 groups for the multicenter randomized study. Patients in the main group (n = 19) underwent a single intraosseous BMAC injection, and those in the comparison group (n = 21) had a similar procedure, but with the use of PRP. Treatment results were assessed at follow-up after 1, 3, 6, and 12 months using the verbal patient satisfaction scale (VSS), visual analog scale (VAS), WOMAC index (Western Ontario and MCMaster Universities osteoarthritis index), and Leken. Results: Estimated effectiveness of the application according to VSS from 1 to 6 months of observation, the opinions of patients were intercepted in the direction of BMAC (up to 65% of positive reviews) in the detection of PRP (up to 55 % of positive reviews). However, during the period of 6 to 12 months of observation we did not get significant results. Interpretation of the application of the VAS scale indicated a pronounced decrease of pain in both groups of patients. However, in the PRP group pain scores were higher. Analysis of the treatment results according to the WOMAC scale allows us to identify significant differences at all periods of observation with the prevalence of results in the BMAC group. Evaluation of the efficacy of therapy according to the Leken index indicated a more than twofold decrease in the index in the first month of observation. Subsequently, we noticed insignificant negative dynamic up to the 12th month of observation. When checking data between groups, the statistical data was significantly better in BMAC group. Conclusion. A single intraosseous injection of BMAC has an advantage at all control periods of observation in comparison with a similar injection of PRP. Both treatments do not cause serious complications.

Hip Arthroscopy With Bone Marrow Aspirate Injection for Patients With Symptomatic Labral Tears and Early Degenerative Changes Shows Similar Improvement Compared With Patients Undergoing Hip Arthroscopy With Symptomatic Labral Tears Without Arthritis

To define the clinical effect of intra-articular injection of iliac crest-derived bone marrow aspirate concentrate (BMAC) at the time of hip arthroscopy in patients with symptomatic labral tears and early radiographic degenerative changes. A retrospective review of a prospectively collected hip registry database was performed. Patients with symptomatic labral tears and Tönnis grade 1 or 2 degenerative changes who underwent labrum-preserving hip arthroscopy with BMAC injection were included and were matched with patients who underwent hip arthroscopy without BMAC injection. Patient-reported outcomes (PROs) collected preoperatively and up to 2 years postoperatively included the modified Harris Hip Score, Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sport, and International Hip Outcome Tool 33 score. Clinical relevance was measured with the minimal clinically important difference, patient acceptable symptom state, and substantial clinical benefit for each outcome score. A total of 35 patients underwent labrum-preserving hip arthroscopy with BMAC injection and were matched with 35 control patients. There were no differences in demographic characteristics between the groups (P > .05). The BMAC group consisted of 22 patients (62.9%) with Tönnis grade 1 changes and 13 (37.1%) with Tönnis grade 2 changes, whereas all 35 control patients had Tönnis grade 0 hips. All PROs were significantly improved in both groups at 2 years, with no difference in improvement. The rate of failure requiring conversion to total hip arthroplasty was 14.3% (mean, 1.6 years postoperatively) in the BMAC group and 5.7% (mean, 7 years postoperatively) in the control group (P= .09). The difference in the frequency of patients achieving the minimal clinically important difference, patient acceptable symptom state, and substantial clinical benefit was not statistically significant between cohorts. In a challenging group of patients with symptomatic labral tears and early radiographic degenerative changes, hip arthroscopy with BMAC injection results in statistically and clinically significant improvement in PROs comparable to a group of patients with nonarthritic hips undergoing hip arthroscopy at short-term follow-up. Level III, retrospective comparative therapeutic trial.

Low Back Pain, Disability, and Quality of Life One Year following Intradiscal Injection of Autologous Bone Marrow Aspirate Concentrate.

Degenerative disc disease is a common cause of chronic low back pain. Surgical intervention is an invasive treatment associated with high costs. There is growing interest in regenerative medicine as a less invasive but direct disc treatment for chronic discogenic low back pain. To evaluate clinical improvement of primary discogenic low back pain with intradiscal injection of autologous bone marrow aspirate concentrate (BMAC). Study Design. Prospective cohort study. Setting. Single, multiphysician center. Patients. 32 adult patients undergoing intradiscal injection of autologous BMAC for the treatment of primary discogenic low back pain. Interventions. Intradiscal injection of autologous BMAC. Main Outcome Measures. Primary outcome measure is visual analog back pain scale (VAS back pain). Secondary outcome measures include ODI, VAS leg pain, and EQ-5D-5L scores. Outcomes were compared from baseline to 1 year. Thirty-two patients (56.3% male) with a mean age of 45.9 years were enrolled, giving 92 treated levels. Mean VAS back and leg pain scores improved from 5.4 to 3.0 (p < 0.001) and 2.8 to 1.3 (p = 0.005), respectively. Mean ODI scores decreased from 33.5 to 21.1 (p < 0.001), and EQ-5D-5L scores improved from 0.69 to 0.78 (p = 0.001). Using established MCID values, 59.4% had clinically significant improvement in VAS back pain, 43.8% in VAS leg pain, and 56.3% in ODI scores. Intradiscal injection of autologous BMAC significantly improved low back pain, disability, and quality of life at one year. This study suggests that intradiscal BMAC has the potential to be an effective nonsurgical treatment for chronic discogenic low back pain.

Use of bone marrow derived mesenchymal stem cells for the treatment of osteoarthritis: A retrospective long-term follow-up study

BackgroundAvailable studies suggest that bone marrow concentrate, highly enriched in mesenchymal stem cells, is a potentially encouraging treatment for knee osteoarthritis. The aim of this retrospective study was to evaluate the clinical outcome in patients affected by this condition after treatment with autologous bone marrow aspirate concentrate (BMAC). Methods55 patients who had undergone a single intra-articular injection of BMAC were administered two questionnaires to clinically evaluate their condition based on patient-reported outcome measures before treatment and at follow-up. ResultsAnalysis of the data collected indicates that patients experienced improvements in Tegner, VAS and WOMAC scores and that all outcomes at the follow-up improved in a statistically significant manner compared to outcomes at baseline. ConclusionsThe changes observed in the different scores examined suggest that a single BMAC injection seems to be a beneficial and safe treatment for knee osteoarthritis.

Combined subchondral and intra-articular injections ofbone marrow aspirate concentrate provide stable results up to 24months.

The aim of this study was to evaluate the clinical and imaging findings up to 24months of follow-up in patients treated with combined subchondral and intra-articular bone marrow aspirate concentrate (BMAC) injections for the treatment of knee osteoarthritis (OA). Thirty consecutive patients (19 males, 11 females) aged between 40 and 75years (mean age 56.4 ± 8.1years) with unilateral symptomatic knee OA (Kellgren-Lawrence 2-3) were included in the study. Patients were treated with combined intra-articular and subchondral bone BMAC injections (total 9ml) under fluoroscopic control. IKDC subjective score, VAS for pain, KOOS, and EQ-VAS were prospectively evaluated up to 24months. Radiographs were performed at baseline and at 24months after the procedure. MRI was evaluated with the WORMS score at baseline, 6-12months, and 24months of follow-up. The statistical analysis was performed using SPSS v.19.0 and for all tests p < 0.05 was considered significant. No major complications and a 13% failure rate were reported. The IKDC subjective score remained stable from 62.6 ± 19.4 at 12months to 63.4 ± 17.1 at 24months (both p < 0.0005 compared to baseline, 40.5 ± 12.5). Similar improvements were reported for all KOOS subscales, while EQ-VAS did not report any significant improvement. VAS pain worsened from 3.0 ± 1.9 at 12months to 4.4 ± 1.8 at the final follow-up (p = 0.0001), although remaining lower compared to the baseline value of 6.3 ± 1.8 (p = 0.002). The radiographic evaluation did not reveal signs of improvement or deterioration of the OA grade. The MRI findings showed a worsening in marginal osteophytes and synovitis, but a significant reduction of bone marrow edema at 24months (p < 0.0005). Combined intra-articular and subchondral BMAC injections provided clinical and imaging benefits up to 24months for the treatment of symptomatic knee OA, with durable clinical results, a low failure rate, and a significant reduction of bone marrow edema.

Clinical and functional evaluation of bone marrow aspirate concentrate vs autologous conditioned serum in the treatment of knee osteoarthritis.

The aim of this study was to compare the efficacy of a single Bone Marrow Aspirate Concentrate (BMAC) with a cycle of 4 Autologous Conditioned Serum (ACS) injections in the treatment of early-stage knee osteoarthritis (OA). Two groups of 12 patients with degenerative knee OA were treated with a single BMAC injection and with a cycle of 4 ACS injections respectively. Follow-up was set at baseline (t0), one-month (t1) and six-months (t2) evaluating VAS for pain, WOMAC index and range of motion (ROM). We reported a significant improvement in WOMAC after BMAC injection both at t1 (p= 0,001) as well as t2 (p< 0,001), plus a reduction of VAS values in BMAC group at six months follow-up (p = 0,024). In contrast, no significant differences in ROM between the two groups were observed. Both the approaches are safe and effective in the treatment of knee OA, with a major efficacy of BMAC.

Prospective double-blind randomised controlled trial protocol comparing bone marrow aspirate concentrate intra-articular injection combined with subchondral injection versus intra-articular injection alone for the treatment of symptomatic knee osteoarthritis

IntroductionSubchondral and intra-articular injections of bone marrow aspirate concentrate (BMAC) showed promising results for knee osteoarthritis (OA) patients. To date, there is no evidence to demonstrate whether the combination of...

P64. Intradiscal injection of autologous bone marrow aspirate concentrate improves low back pain at one year

<h3>BACKGROUND CONTEXT</h3> Chronic low back pain is one of the leading causes of disability and poor quality of life in the US and worldwide. A common cause of chronic low back pain is degenerative disc disease. Current nonsurgical treatments for degenerative disc disease-associated low back pain are typically effective. However, for patients who fail these treatments, surgical fusion is often used as last line treatment. Surgical treatment is associated with higher health care expenditures and a more invasive procedure. As such, there is growing interest in the field of regenerative medicine and stem cell therapy as a less invasive treatment for low back pain. <h3>PURPOSE</h3> The purpose of this study was to investigate the effect of autologous bone marrow aspirate concentrate (BMAC) on patients with symptomatic lumbar degenereative disc disease at one year. <h3>STUDY DESIGN/SETTING</h3> Single institution prospective cohort study. <h3>PATIENT SAMPLE</h3> A total of 32 adult patients. <h3>OUTCOME MEASURES</h3> Mean ODI, EQ-5D-5L, VAS back pain, and VAS leg pain scores. <h3>METHODS</h3> A total of 32 consecutive patients over the age of 18 years diagnosed with discogenic low back pain clinically or by discography who underwent injection of autologous intradiscal BMAC at a single multi surgeon orthopedic spine center were included in this study. Active smokers and patients who had pain generators other than purely discogenic pain were excluded. For primary analysis, patients completed baseline and 1 year post-injection ODI, VAS back, VAS leg, and EQ-5D-5L questionnaires; their scores were compared over time. Preprocedural lumbar MRIs were reviewed for Modic changes and assigned a Pfirrmann grade. Thirteen postprocedural MRIs were available and reviewed using the same parameters. <h3>RESULTS</h3> Thirty-two patients (56.3% male) with a mean age of 45.9 (range 19-65) underwent BMAC injection between 1 and 6 levels completed 1 year follow up. Mean VAS back and leg scores improved from 54.0 to 30.4 (p < 0.001) and 27.9 to 13.3 (p=0.005), respectively. Mean ODI scores decreased from 33.5 to 21.1 (p < 0.001), and EQ-5D-5L scores improved from 0.69 to 0.78 (p=0.001). Using established minimum clinically important difference values, 59.4% of patients saw a clinically significant improvement in VAS back pain, 43.8% in VAS leg pain, and 56.3% in ODI scores. On pre-procedural MRIs, 62.5% of patients had a Modic score of 1 or 2 and 93.8% had a Pfirrmann grade of 3 or higher. Postprocedural MRIs were available for 13 patients, and 61.5% had no measurable change in Pfirrmann grade. Three patients worsened by one Pfirrmann grade and one improved by 1 grade. <h3>CONCLUSIONS</h3> Intradiscal injection of autologous BMAC was shown to significantly improve pain and quality of life at one year. Additionally, this study meets 88% of recently published AAOS reporting standards for studies relating to mesenchymal stem cells. The results of this study suggest that intradiscal injection of autologous BMAC has the potential to be an effective non-surgical treatment for chronic discogenic low back pain. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

FUNCTIONAL OUTCOME OF EARLY STAGES OF OSTEOARTHRITIS KNEE TREATED WITH BONE MARROW ASPIRATE CONCENTRATE AND INTRAARTICULAR STEROID

Objectives: The objective is to observe the functional outcome of early stages of osteoarthritis knee treated with Bone marrow aspirate concentrate (BMAC) and Intraarticular steroid A total of 60Methods: patients of both genders aged 45–60 years were included in the study. 5ml - 10ml of Bone marrow was aspirated under local anaesthesia from iliac crest, ipsilateral / contralateral to the knee, with a bone marrow aspiration needle and was centrifuged and processed. 40 mg of Triamcinolone was mixed with BMAC and was administered in the knee joint. This procedure was done under Day Care. At 6-month follow-up, BMAC injection with 40 mg triamcinolone signicantly improved knee pain andResults: function. BMAC injection with 40 mg triamcinolone signicantly improved knee pain and function in early stages ofConclusion: osteoarthritis knee

Injectable orthobiologics in professional football (soccer) players: a systematic review

IntroductionThe use of orthobiologics in the treatment of sports injuries has increased because of athletes' desire to heal faster and early return to sports. These therapies comprise platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC), and mesenchymal stem cells (MSCs) injections which promote the native musculoskeletal system healing and regeneration potential. ObjectivesTo evaluate the clinical outcomes of PRP, BMAC, and MSCs injections in treating sport-related injuries for professional football (PF) players. MethodsFollowing the PRISMA guidelines, PubMed, Embase, Scopus, and The Cochrane Central Register of Controlled Trials (CENTRAL) databases were accessed in January 2022. Clinical studies evaluating the outcomes of PRP, BMAC, and MSCs injections in sports-related injuries among PF players were considered eligible. The methodological quality was assessed using the modified Coleman Methodology Score (mCMS), and a short version of the Minimum Information for studies evaluating Biologics in Orthopaedics (MIBO) was recorded for every PRP study. ResultsEleven studies met the eligibility criteria. All implemented PRP, most of them in treating muscle and ligament injuries. Only one study implemented BMAC, and no study implementing MSCs injections in PF players was found. The average mCMS value demonstrated a poor level of methodological quality. Studies reported only 26.13% of the relevant data of the short-MIBO. ConclusionsThere is scarce evidence on orthobiologics implementation in PF players other than PRP injections to treat muscle, ligament cartilage, bone, tendon, fascial, and capsular injuries. However, evidence lacks methodological quality and adherence to MIBO to support its implementation.

Bone Marrow Aspirate Concentrate Is Equivalent to Platelet-Rich Plasma for the Treatment of Knee Osteoarthritis at 2 Years: A Prospective Randomized Trial

Background: Autologous platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMC) are being used clinically as therapeutic agents for the treatment of knee osteoarthritis. Purpose/Hypothesis: The purpose of this study was to compare the efficacy of BMC and PRP on pain and function in patients with knee osteoarthritis up to 24 months after injection. It was hypothesized that patients receiving BMC would have better sustained outcomes than those receiving PRP. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: A total of 90 participants aged between 18 and 80 years with symptomatic knee osteoarthritis (Kellgren-Lawrence grades 1-3) were randomized into 2 study groups: PRP and BMC. Both groups completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and subjective International Knee Documentation Committee (IKDC) questionnaire before and 1, 3, 6, 9, 12, 18, and 24 months after a single intra-articular injection of leukocyte-rich PRP or BMC. A linear mixed-effects model was performed to quantify the effects over time and the difference between the groups. This model has the random effect for time to assess the extent in which the change over time differs from one person to another. Results: An overall 84 patients completed questionnaires from baseline to 12 months; however, 17 patients (n = 9; PRP group) were lost to follow-up at 18 months and 25 (n = 13; PRP group) at 24 months. There were no statistically significant differences in IKDC (P = .909; 95% CI, −6.26 to 7.03) or WOMAC (P = .789; 95% CI, −6.26 to 4.77) scores over time between the groups. Both groups had significantly improved IKDC (P < .001; 95% CI, 0.275-0.596) and WOMAC (P = .001; 95% CI, −0.41 to −0.13) scores from baseline to 24 months after the injection. These improvements plateaued at 3 months and were sustained for 24 months after the injection, with no difference between PRP and BMC at any time point. Conclusions: For the treatment of osteoarthritis, PRP and BMC performed similarly out to 24 months. BMC was not superior to PRP. Registration: NCT03289416 (ClincalTrials.gov identifier).

Bone marrow aspirate concentrate versus platelet-rich plasma for treating knee osteoarthritis: a one-year non-randomized retrospective comparative study

BackgroundKnee osteoarthritis (OA) is a debilitating condition affecting human body biomechanics and quality of life. Current standard care for knee OA leads to trivial improvement and entails multiple adverse effects or complications. Recently, investigational cell therapies injected intra-articularly, such as bone marrow aspirate concentrate (BMAC) and platelet-rich plasma (PRP), have shown safety and therapeutic potency providing patients with pain relief. In the current retrospective comparative study, we investigated the differences in pain and functional improvements in patients with symptomatic knee OA receiving intra-articular injections of BMAC vs PRP.MethodsPain and functionality scores were measured at baseline and at different time points post-injection over 12 months, using 3 self-administered, clinically validated questionnaires: the visual analogue scale (VAS) for assessing pain intensity, the knee injury and osteoarthritis outcome score (KOOS) for evaluating functionality and knee-related quality of life, and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) for evaluating physical function. The repeated-measures general linear model with Sidak test for pairwise comparisons was used to investigate the influence of the treatment on the score evolution within groups (between baseline and each time point) and between groups (overall).ResultsThe BMAC group (n = 26 knees) significantly improved in VAS, KOOS, and WOMAC scores between baseline and 12 months (57.4, 75.88, and 73.95% mean score improvement, respectively). In contrast, the PRP group (n = 13 knees) witnessed nonsignificant improvement in all scores. BMAC, in comparison to PRP, induced significant improvement in outcomes by 29.38% on the VAS scale, 53.89% on the KOOS scale, and 51.71% on the WOMAC scale (P < .002, P < .01, P < .011, respectively).ConclusionsIntra-articular autologous BMAC injections are safe, effective in treating pain, and ameliorate functionality in patients with symptomatic knee OA to a greater extent than PRP injections.Graphical abstractIntra-articular autologous BMAC therapy is safe and provides more relief to patients with symptomatic knee osteoarthritis compared to PRP therapy.

Intraosseous Injection of Autologous Bone Marrow Aspirate Concentrate and Platelet-Rich Plasma for Treatment of Knee Osteoarthritis

The aim of the study was to determine the effectiveness of autologous bone marrow aspirate concentrate (BMAC) and platelet-rich plasma (PRP) intraosseous injection in the treatment of patients with knee OA stages II-III. Materials and Methods. The multicenter randomized study involved 40 patients (27 women, 13 men, average age 67.07.8 years, BMI 32.74.8, duration of disease 17.33.7 months) with knee OA of stages II-III according to the Kellgren-Lawrence (K-L) classification. Patients of the main (BMAC group) group (n = 19) underwent a single intraosseous injection of BMAC, in the comparison group (n = 21) a PRP injection (PRP group). The results were evaluated after 1, 3, 6, 12 months with the verbal rating scale (VRS), VAS, Leken and WOMAC scales. Results. Comparison of the results in the groups on the VRS showed that at an earlier time (3 and 6 months), the preferences of patients were in favor of the treatment of BMAC (65% and 55% positive reviews) before PRP (55% and 45% positive reviews), whereas after 12 months the differences were insignificant. Analysis of VAS indicators in patients of both groups indicated a more pronounced decrease in the severity of pain syndrome after BMAC intraosseous injection. The analysis of the Leken scale indicators showed in favor of BMAC throughout the entire observation period, the differences were most pronounced in the first 3 months of observation. The ratio of the values of the WOMAC index in both patients groups indicated statistically significant differences that persisted in all periods of follow-up, the increase in indicators occurred to a lesser extent after the introduction of BMAC compared with PRP. Conclusion. A single intraosseous BMAC injection has an advantage over a similar PRP injection in terms of pain, knee function and physical activity of patients at all follow-up periods. Both methods of treatment are equally safe.