Bone Marrow Aspirate Concentrate Research Articles

Encouraging effect of autologous bone marrow aspirate concentrate in rehabilitation of children with cerebral palsy.

In this study, we used autologous bone marrow aspirate concentrate (BMAC) transplantation to treat children with cerebral palsy (CP) to improve their motor and cognitive functions. Forty-two patients with CP received BMAC. The transplantation of stem cells via the intrathecal route includes three BMAC applications. The patients' examination was before the injection of stem cells, with follow-ups on 1, 3, 6, and 12 months after the injections. The assessments included the gross motor function classification scale, the Ashworth scale, and the Learning accomplishment profile-diagnostic scale. This study included 42 patients with CP who received three BMAC intrathecal administrations. A personalized home rehabilitation program was designed and included for each patient in the study. After the treatment, we observed a reduction of spasticity in 58% of patients and significant cognitive improvement in 35% of patients. The outcome of this study indicates that stem cell therapy and personalized training can improve the development of children with CP. The crucial goal of this therapeutic intervention is to substitute injured tissue with new tissues by activating the regenerative capacity of stem cells.

A review of the efficacy of intraarticular hip injection for patients with hip osteoarthritis: To inject or not to inject in hip osteoarthritis?

Hip injection (HI) for osteoarthritis (OA) are in vogue nowadays. Corticosteroids (CSs) and hyaluronic acid (HA) gel are the two most common agents injected into the hip. Off late, platelet-rich plasma (PRP), mesenchymal stem cell (MSC), bone marrow aspirate concentrate (BMAC), local anesthetic (LA) agents, non-steroidal anti-inflammatory drugs (NSAIDs) and their different combinations have also been injected in hips to provide desired pain relief. However, there is a group of clinicians who vary of these injections. A search of the literature was performed on PubMed, Cochrane Library, and DOAJ using the keywords “hip osteoarthritis injection”. Data were analyzed and compiled. Intraarticular CSs are effective in providing the desired pain relief in OA hip, but repeated injections should be avoided and the interval between HI and hip arthroplasty must be kept for more than three months. Methylprednisolone or triamcinolone are combined with 1% lidocaine or 0.5% bupivacaine. Chondrotoxic effects of LA is a concern. Although national guidelines do not favor the use of HA for hip OA, numerous publications have favored its usage for a moderate grade of OA. The PRP, MSC, and BMAC are treatment options with great potential; however, currently, the evidence is conflicting on their role in hip OA. There is always a risk of septic arthritis, particularly when aseptic precautions are not followed, and clinicians must vary of this complication.

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).

Does the Choice of Acellular Scaffold and Augmentation With Bone Marrow Aspirate Concentrate Affect Short-term Outcomes in Cartilage Repair? A Systematic Review and Meta-analysis

Background: Matrix-induced chondrogenesis (MIC) is a promising treatment option for critical-size cartilage lesions of the knee; however, there exists substantial heterogeneity in the choice of acellular scaffold matrix for MIC cartilage repairs. Hypothesis: The choice of acellular matrix will not affect patient outcomes after MIC cartilage repair procedures, and the addition of concentrated bone marrow aspirate (cBMA) will improve short-term patient outcomes regardless of matrix choice. Study Design: Meta-analysis; Level of evidence, 4. Methods: Studies were stratified by matrix type: multilayered, single layered, and gel based. Continuous outcomes were analyzed with pairwise meta-analysis using the inverse variance model with random effects applied. Binary outcomes were analyzed as pooled proportions in a single-arm fashion; after which, reconstruction of relative risks (RRs) with confidence intervals was performed using the Katz logarithmic method. Results: A total of 876 patients were included: 469 received multilayered bioscaffolds; 238, gel-based scaffolds; and 169, single-layered scaffolds. The mean age of patients was 36.2 years (95% CI, 33.9 to 38.4), while the mean lesion size was 3.91 cm2 (95% CI, 3.40 to 4.42). The weighted mean follow-up was 23.8 months (95% CI, 20.1 to 27.6). Multilayered bioscaffolds were most effective at improving visual analog scale scores (P = .03; weighted mean difference [WMD], −4.44 [95% CI, −4.83 to −4.06]; P < .001). There were significantly lower risks of incomplete defect filling for gel-based scaffolds when compared with multilayered scaffolds (RR, 0.78 [95% CI, 0.69 to 0.88]; P < .001) and single-layered scaffolds (RR, 0.58 [95% CI, 0.41 to 0.81]; P = .001). Augmentation with cBMA further improved clinical scores across all scaffolds, with significant improvements in Tegner score (P = .02), while decreasing incomplete defect filling rates as well. There was significantly greater improvement in visual analog scale scores (P = .01) for single-layered scaffolds with cBMA augmentation (WMD, −4.88 [95% CI, −5.38 to −4.37]; P < .001) as compared with single-layered scaffolds without cBMA augmentation (WMD, −4.08 [95% CI, −4.46 to −3.71]; P < .001). All significant improvements were below their respective minimum clinically important differences. Conclusion: While cartilage repair with acellular scaffolds provides significant improvements in pain and function for patients, there is insufficient clinical evidence to suggest which scaffold material is the most superior in influencing such improvements. The enhancement of cartilage repair procedures with cBMA may provide further functional improvements and improve defect filling; however, more long-term evidence is required to evaluate the effects.

The quality and accuracy of direct-to-consumer biologic marketing for shoulder pathology are poor.

BackgroundThe growing role of biologic therapies as adjunct or standalone procedures in orthopedic practice has led to greater levels of direct-to-consumer biologic marketing. The present study aims to assess the quality, accuracy, and readability of online educational resources available to patients regarding biologic therapies for shoulder pathology.MethodsEight search terms relevant to shoulder biologic therapies (shoulder + BMAC, Bone Marrow Aspirate Concentrate, PRP, Platelet Rich Plasma, Lipogems, Adipose Tissue, Biologic therapy, and Stem cell therapy) were searched across three separate search engines. The first 25 websites of each search were recorded. Duplicate websites and those not specific to shoulder pathology were excluded. Three evaluators independently assessed quality using an author-derived scoring rubric for a total of 25 possible points and accuracy for a total of 12 possible points. The Flesch-Kincaid readability test was used to quantify reading levels. Websites were further characterized by authorship and the presence of commercial bias.ResultsOf the 600 results from the initial search, 59 met inclusion criteria. The mean quality of the websites was poor, with 7.97 ± 2.3 of 25 points (32%). The mean accuracy was low, with 8.47 ± 1.52 of 12 points (71%). The average reading level was 11.2 ± 1.93, with 32% of websites' reading at greater than 12th grade reading level. The search terms of “shoulder PRP” and “shoulder Platelet Rich Plasma” yielded the highest quality results (mean = 8.14 ± 2.63). “shoulder Lipogems” and “shoulder Adipose tissue” yielded the most accurate results (mean = 9.25 ± 0.96). “shoulder BMAC” and “shoulder bone marrow aspirate concentrate” were most difficult to read (mean = 12.54 ± 3.73). Sixty-four percent of websites were authored by physicians, hospitals, or medical groups. The accuracy of websites authored by health care professionals was significantly higher than the accuracy of those authored by other industry sources (P = .01). Fifteen percent of websites demonstrated commercial bias.DiscussionThe online resources available to patients seeking information about biologic therapies for the treatment of shoulder pathologies are of very poor quality, moderately poor accuracy, and advanced readability. Providers should caution patients about the reliability of direct-to-consumer biologic marketing for shoulder pathology.ConclusionThe information available to patients online regarding the diagnosis, evaluation, and treatment of shoulder pathology with biologic therapies is of poor quality and accuracy and difficult readability.

Impact of the Process Variables on the Yield of Mesenchymal Stromal Cells from Bone Marrow Aspirate Concentrate.

Human bone marrow (BM) has been highlighted as a promising source of mesenchymal stromal cells (MSCs) containing various growth factors and cytokines that can be potentially utilized in regenerative procedures involving cartilage and bone. However, the proportion of MSCs in the nucleated cell population of BM is only around 0.001% to 0.01% thereby making the harvesting and processing technique crucial for obtaining optimal results upon its use in various regenerative processes. Although several studies in the literature have given encouraging results on the utility of BM aspiration concentrate (BMAC) in various regenerative procedures, there is a lack of consensus concerning the harvesting variables such as choice of anesthetic agent to be used, site of harvest, size of the syringe to be used, anticoagulant of choice, and processing variables such as centrifugation time, and speed. In this review article, we aim to discuss the variables in the harvesting and processing technique of BMAC and their impact on the yield of MSCs in the final concentrate obtained from them.

Bone Marrow Aspirate Concentrate Augmentation May Accelerate Allograft Ligamentization in Anterior Cruciate Ligament Reconstruction: A Double-Blinded Randomized Controlled Trial

To assess the effect of bone marrow aspiration concentrate (BMAC) augmentation on clinical outcomes and magnetic resonance imaging (MRI) findings in anterior cruciate ligament (ACL) reconstruction (ACLR) with bone-patellar tendon-bone (BTB) allografts. A double-blinded, randomized controlled trial was conducted on 80 patients undergoing ACL reconstruction using BTB allografts. Patients were randomized to 2 groups: (1) bone marrow aspirate was collected from the iliac crest, concentrated, and approximately 2.5 mL was injected into the BTB allograft, or (2) a small sham incision was made at the iliac crest (control). MRI was performed at 3 months and 9 months postoperatively to determine the signal intensity ratio of the ACL graft. Seventy-three patients were available for follow-up at 1-year postoperatively (36 BMAC, 37 control). International Knee Documentation Committee (IKDC) scores were significantly greater in the BMAC group versus the control at the 9-month postoperative period (81.6 ± 10.5 vs 74.6 ± 14.2, P= .048). There was no significant difference in the proportion of patients who met the minimal clinically important difference for IKDC between the BMAC and control groups at 9 months (89% vs 85%; P= .7). Three months postoperatively, signal intensity ratio of the inferior third of the ACL graft was significantly greater in the BMAC group versus the control group (3.2 ± 2.2 vs 2.1 ± 1.5; P= .02). Patients who received BMAC augmentation of the BTB allograft during ACL reconstruction demonstrated greater signal intensity scores on MRI at 3 months, suggesting increased metabolic activity and remodeling, and potentially accelerated ligamentization. Additionally, patients in the BMAC group had greater patient-reported outcomes (IKDC) at 9 months postoperatively when compared with those who underwent a standard surgical procedure. There was no significant difference in the proportion of patients who met the minimal clinically important difference for IKDC between the BMAC and control groups at 9 months, suggesting limited clinical significance at this time point. I, randomized control trial.

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.

Mesenchymal stem cells surpass the capacity of bone marrow aspirate concentrate for periodontal regeneration.

Regenerative approaches using mesenchymal stem cells (MSCs) have been evaluated to promote the complete formation of all missing periodontal tissues, e.g., new cementum, bone, and functional periodontal ligaments. MSCs derived from bone marrow have been applied to bone and periodontal defects in several forms, including bone marrow aspirate concentrate (BMAC) and cultured and isolated bone marrow mesenchymal stem cells (BM-MSCs). This study aimed to evaluate the periodontal regeneration capacity of BMAC and cultured BM-MSCs in the wound healing of fenestration defects in rats. Methodology: BM-MSCs were obtained after bone marrow aspiration of the isogenic iliac crests of rats, followed by cultivation and isolation. Autogenous BMAC was collected and centrifuged immediately before surgery. In 36 rats, fenestration defects were created and treated with suspended BM-MSCs, BMAC or left to spontaneously heal (control) (N=6). Their regenerative potential was assessed by microcomputed tomography (µCT) and histomorphometry, as well as their cell phenotype and functionality by the Luminex assay at 15 and 30 postoperative days. Results: BMAC achieved higher bone volume in 30 days than spontaneous healing (p<0.0001) by enhancing osteoblastic lineage commitment maturation, with higher levels of osteopontin (p=0.0013). Defects filled with cultured BM-MSCs achieved higher mature bone formation in early stages than spontaneous healing and BMAC (p=0.0241 and p=0.0143, respectively). Moreover, significantly more cementum-like tissue formation (p<0.0001) was observed with new insertion of fibers in specimens treated with BM-MSCs within 30 days. Conclusion: Both forms of cell transport, BMAC and BM-MSCs, promoted bone formation. However, early bone formation and maturation were achieved when cultured BM-MSCs were used. Likewise, only cultured BM-MSCs were capable of achieving complete periodontal regeneration with inserted fibers in the new cementum-like tissue.

Clinical and Radiological Outcomes of Autologous Osteochondral Transplantation with and without Micronized Allograft Cartilage Matrix Augmentation for Osteochondral Lesions of the Talus

Category:Ankle; Basic Sciences/Biologics; TraumaIntroduction/Purpose:Autologous osteochondral transplantation (AOT) using a cylindrical graft, in the treatment of osteochondral lesions of the talus (OLT) is typically indicated for patients with larger lesions. However, with lesions that are irregular in shape, the AOT graft may not completely replace the lesion. For these lesions, we utilize Extracellular Matrix Cartilage Allograft (EMCA) augmentation in AOT to act as a physiologic grout between the host and graft interface. The purpose of this study was to evaluate the clinical and radiological outcomes of AOT with concentrated bone marrow aspirate (CBMA) and EMCA augmentation in the treatment of OLT.Methods:A retrospective analysis comparing patients treated with AOT/CBMA alone and AOT with CBMA/EMCA was performed. Clinical outcomes were evaluated with the use of the Foot and Ankle Outcome Score (FAOS). Magnetic resonance imaging (MRI) was evaluated with the use of the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score. Cyst formation was also evaluated on postoperative MRI.Results:Twenty-six patients were included in the AOT + CBMA/EMCA group, with 10 males and 16 females. Thirty-four patients were included in the AOT/CBMA group, with 17 males and 17 females. The mean symptoms, pain, ADL, sports activities, and QOL scores in FAOS significantly improved in both groups (p<0.001), but there was no significant difference between groups at final follow-up. There was no significant difference between the mean MOCART scores between groups (p=0.118). In the AOT/CBMA group, 2 patients (7.7%) complained of knee pain and 5 patients (19.2%) required additional surgery (2 hardware removals and 3 arthroscopic debridements of scar tissue in the ankle). In the AOT + CBMA/EMCA group, 3 patients (8.8%) complained of knee pain, and one patient (2.9%) required hardware removal.Conclusion:The current study demonstrated that AOT combined with CBMA and EMCA was an effective surgical treatment for OLT, providing good clinical and radiological outcomes. However, the benefit of combining ECMA with CBMA in small chondral defects at the host graft interface may be marginal as the biologic effect is induced by the CBMA and the mechanical scaffold effect of ECMA may not be required in such small defects.

Lesser Tarsal Metatarsal Joint Fusion Using Nitinol Staples, Bone Marrow Aspirate Concentrate and a Calcaneal Bone Dowel: A Retrospective Comparative Analysis

Category:Midfoot/Forefoot; Lesser ToesIntroduction/Purpose:Estimates suggest nonunion rates following lesser tarsometatarsal (TMT) fusion are up to 11.4%. Various techniques have been employed to improve fusion rates; however, none have shown significant improvement compared to other techniques. Autologous bone dowels, bone marrow aspirate concentrate (BMAC) and continuous compression devices (CCDs), such as nitinol staples, have each shown promising fusion rates in orthopedic literature. There is limited data that suggests using these techniques in conjunction with one another has been successfully employed in the fusion of lesser TMT joints. The aim of this study was to describe our technique using autologous calcaneal bone graft, CCDs and BMAC for lesser TMT fusion and to investigate whether this method improves fusion rates and decreases time to fusion in comparison to traditional constructs.Methods:All patients undergoing arthrodesis of the lesser (2nd/3rd) TMT joints from January 2015 to January 2020 were identified. Exclusion criteria included inadequate clinical or radiographic follow-up, those with only 1st TMT joint arthrodesis, and those less than 18 years old. Chart review allowed patient demographics, risk factors and surgical approach to be identified.Twenty patients (28 lesser TMT joints) treated with arthrodesis by the senior surgeon met inclusion criteria. These patients were then divided into two groups: 1) novel treatment (Nitinol staple, BMAC and calcaneal dowel) and 2) traditional treatment (compression plate and screw construct). We then assessed for radiographic union, time to union and complications.Results:All lesser TMT joints in the novel treatment arm went on to successful clinical and radiographic fusion. The radiographic union rate of the traditional treatment arm was 92% (P=.08). Overall time to fusion was 56 and 82 days for the novel and traditional constructs respectively (P <.05). All patients, regardless of construct, had returned to full weight bearing and maintained hardware at most recent follow-up (minimum 6 months).Conclusion:Continuous compression devices such as the nitinol staple and use of biologic adjuvants appear to decrease nonunion rates and significantly shorten overall time to fusion in lesser TMT joints. Further investigation towards identifying patient specific factors for nonunion is warranted.

Biologic Knee Arthroplasty in 360 Degrees for Early Osteoarthritis Treatment

This article gives a comprehensive review of a two-step single surgical alternative that searches to preserve the patient's cartilage and joint. It addresses the knee from a 360-degree perspective; First, from the articular side, full-thickness cartilage lesions are treated with hyaluronic acid (HA) scaffold combined with bone marrow aspirate concentrate (BMC), which restores the articular cartilage with a hyaline-like tissue. Then, deep inside the subchondral bone, a minimally invasive procedure called Osteo-Core-Plasty (OCP) is conducted when it is affected. This procedure serves to restore the subchondral bone with structural bone autograft and BMAC derived signaling cells. The HA-BMC cartilage preserving technique with more than ten years of follow-up provides persistent and prothesis sparing surgical results, while OCP offers the further benefits of the new technology for deep joint bone-core treatment and regeneration with significant improvement in clinical score outcomes and magnetic resonance imaging. Given the evidence, these articular preservation techniques can be considered the new paradigm knee arthroplasty surgery as they can achieve a valuable and holistic approach to early osteoarthritis treatment.

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.

Baghdad's first success in Bone Marrow Aspirate Concentrate procedure

Introduction-Bone Marrow Aspirate Concentrate procedure (BMAC) is a novel regenerative technique. Aim-to show BMAC's success in relieving osteoarthritic knee sufferings in Iraqi patients. Methods-It is a retrospective, descriptive investigation of 300 Iraqi patients who suffered from grades 1-3 Kellgren-Lawrence Grading for osteoarthritic knees, aged (35- 64) years, from both genders after oral consent at "Al Zahrawy Center for Stem Cells" in Baghdad over six months. The investigators utilize a verbal pain scale for pain evaluation. Results-Of 300 patients, 195 (65 %) were women; the commoner patients had grade two. Sixty-four (21.3 %) patients discontinue their follow-up. Grade three patients manifest inadequate response. A single injection of BMAC had a good effect on pain score and night stiffness. There were 143 (47 %) patients still suffering in the sixth month, while 95 (31.6 %) patients required extra BMAC. Conclusion-It is the first successful BMAC report in Iraqi patients for relieving osteoarthritic knee sufferings.

Improved Outcomes with Arthroscopic Bone Marrow Aspirate Concentrate and Cartilage-Derived Matrix Implantation versus Chondroplasty for the Treatment of Focal Chondral Defects of the Knee Joint: A Retrospective Case Series

PurposeTo compare the outcomes of patients undergoing treatment of focal chondral defects (FCDs) of the knee joint with chondroplasty versus bone marrow aspirate concentrate (BMAC) and cartilage-derived matrix (CDM) implantation.MethodsA retrospective chart review was performed for patients diagnosed with Outerbridge grade 3-4 FCDs. Patients were included if they were treated arthroscopically with BMAC/CDM implantation or chondroplasty alone between March 2016 and May 2019 and had more than 1-year follow-up. Postoperative outcomes included the visual analog scale (VAS) for pain; University of California, Los Angeles (UCLA) activity scores; Knee Outcome Survey (KOS) Activities of Daily Living (ADL) and Sports subscores; postoperative corticosteroid or hyaluronic acid injections; subsequent surgeries; and conversion to total knee arthroplasty.ResultsA total of 98 patients were identified with a mean follow-up in BMAC/CDM of 24 months (range 13-41 months) and in chondroplasty of 44 months (range 34-55 months). A subanalysis was performed to control for significant differences in age, which yielded 39 patients, ages 40-60 years. Within the subanalysis group, mean VAS scores were significantly lower in the BMAC/CDM group (1.7 vs 4.4; P = .005) and mean UCLA scores were significantly greater (7.1 vs 5.0; P = .002). Mean improvement in VAS and UCLA scores were similar between the BMAC/CDM and chondroplasty groups (–3.7 vs –1.3; P = .71, 1.9 vs 0.1; P = .14, respectively). Mean KOS ADL and Sports subscores were significantly greater among patients in the BMAC/CDM group (87% vs 55%; P = .001, 71% vs 41%; P = .002, respectively). There were no differences in postoperative injections, subsequent surgeries, or conversion to total knee arthroplasty between the BMAC/CDM and chondroplasty groups.ConclusionsPatients with grade 3-4 FCDs of the knee had improved postoperative outcomes when treated with BMAC/CDM implantation versus chondroplasty alone, as evidenced by a significant improvement in VAS and UCLA scores and significantly greater postoperative KOS ADL, and KOS Sport subscores.Level of EvidenceIV, therapeutic case series.

Arthroscopic rotator cuff repair with biologically enhanced patch augmentation.

The purpose of this guide is to illustrate an arthroscopic rotator cuff repair (RCR) with two techniques for biologically enhanced patch augmentation. Massive rotator cuff tears (> 5 cm) and revision RCR. Active joint or systemic infection; severe fatty muscle atrophy; severe glenohumeral arthropathy; American Society of Anesthesiologists Physical Status (ASA PS)IV. Dermal allograft patch augmented with concentrated bone marrow aspirate (cBMA), platelet-rich plasma (PRP) and platelet-poor plasma (PPP); or Regeneten patch augmented with bursa, PRP, PPP, and autologous thrombin. A30° abduction sling for 6weeks; unrestricted active-assisted external rotation and forward elevation after 12weeks; focus on restoration of scapular stability and strength. A total of 22 patients received revision massive RCR using adermal allograft patch enhanced with cBMA and PRP with amean follow-up of 2.5years (1.0-5.8years). There was asignificant improvement in the preoperative Simple Shoulder Test (SST). There was also atrend towards improved pain and American Shoulder and Elbow Surgeons (ASES) Shoulder Score. In this cohort, 45% reached the minimal clinically important difference (MCID), 41% achieved substantial clinical benefit (SCB), and 32% had apatient-acceptable symptomatic state (PASS) for the ASES score. Preliminary data using the Regeneten patch technique with bursa, PRP, PPP, and autologous thrombin was prospectively collected in five patients between 05/2020 and 03/2021 at the author's institution. Mean follow-up was 6.5 ± 1.3 (6-8months). There was an improvement from preop to postop in pain, ASES, SANE, Constant-Murley (CM) score and active range of motion.

High Variability of Mesenchymal Stem Cells Obtained via Bone Marrow Aspirate Concentrate Compared With Traditional Bone Marrow Aspiration Technique.

Background:Bone marrow aspirate (BMA) is a common source for harvesting mesenchymal stem cells (MSCs), other progenitor cells, and associated cytokines and growth factors to be used in the biologic treatment of various orthopaedic pathologies. The aspirate is commonly centrifuged into a concentrated volume that can be immediately administered to a patient using commercially available kits. However, the handling and efficacy of BMA concentrate (BMAC) are still controversial.Purpose:To characterize BMA versus BMAC for MSC quantity, potency, and cytokine profile.Study Design:Controlled laboratory study.Methods:From 8 participants (age, 17-68 years), 30 mL of bone marrow was aspirated by a single surgeon from either the proximal humerus or distal femur and was separated into 2 equal samples. One sample was kept as BMA, and the other half was centrifuged into BMAC. The 2 samples then underwent flow cytometry for detection of MSCs, cell analysis for colony-forming units (CFUs), and cytokine profiling. A 2-tailed t test was used to detect differences between MSCs, CFUs, and cytokine density concentrations between BMA and BMAC.Results:The average concentration of MSCs in both BMA and BMAC was 0.001%. Average MSC events detected by flow cytometry were significantly higher in BMA versus BMAC (15.1 and 8.1, respectively; P < .045). Expanded MSCs demonstrated similar phenotypes, but CFUs were significantly increased in BMA compared with BMAC (104 vs 68 CFUs, respectively; P < .001). Total protein concentration and cytokine profiling demonstrated great variability between BMA and BMAC and between patients. Most importantly, BMAC failed to concentrate MSCs in 6 of 8 samples.Conclusion:There is great variability in MSC concentration, total protein concentration, and cytokine profile between BMA and BMAC.Clinical Relevance:When studying the clinical efficacy of BMAC, one must also evaluate the sample itself to determine the presence, concentration, and potency of MSCs if this is to be considered a cell-based therapy. Further standard operating procedures need to be investigated to ensure reproducible results and appropriate treatments.

Treatment of Full-Thickness Acetabular Chondral Flaps During Hip Arthroscopy: Bone Marrow Aspirate Concentrate Versus Microfracture.

Background:The optimal treatment strategy for patients with full-thickness chondral flaps undergoing hip arthroscopy is controversial.Purpose:To compare functional outcomes of patients who underwent bone marrow aspirate concentrate (BMAC) application with those of patients who underwent microfracture.Study Design:Cohort study; Level of evidence, 3.Methods:This was a retrospective case series of prospectively collected data on patients who underwent arthroscopic acetabular labral repair by 1 surgeon between June 2014 and April 2020. The inclusion criteria for this study were age ≥18 years, preoperative radiographs of the pelvis, arthroscopic acetabular labral repair, exposed subchondral bone with overlying chondral flap seen at the time of hip arthroscopy, microfracture or BMAC to address this lesion, and completed patient-reported outcome measures (PROMs) (International Hip Outcome Tool–33 [iHOT-33], Hip Outcome Score–Activities of Daily Living [HOS-ADL], Hip Outcome Score–Sports Subscale [HOS-Sport], modified Harris Hip Score [mHHS], and visual analog scale [VAS] for pain) at enrollment and 12-month follow-up. Clinical outcomes were assessed using PROM scores.Results:A total of 81 hips with full-thickness chondral flaps were included in this study: 50 treated with BMAC and 31 treated with microfracture. There were no significant differences between groups in age, sex, body mass index, tear size, radiographic osteoarthritis, or radiographic femoroacetabular impingement. In the BMAC cohort, all PROM scores improved significantly from preoperatively to follow-up: 41.7 to 75.6 for iHOT-33, 67.6 to 91.0 for HOS-ADL, 41.5 to 72.3 for HOS-Sport, 59.4 to 87.2 for mHHS, and 6.2 to 2.2 for VAS pain (P < .001 for all). In the microfracture cohort, the score improvements were 48.0 to 65.1 for iHOT-33 (P = .001), 80.5 to 83.3 for HOS-ADL (P = .275), 59.2 to 62.4 for HOS-Sport (P = .568), 70.4 to 78.3 for mHHS (P = .028), and 4.9 to 3.6 for VAS pain (P = .036). Regarding clinically meaningful outcomes, 77.6% of the BMAC group and 50.0% of the microfracture group met the minimal clinically important difference for iHOT-33 at the 12-month follow-up (P = .013).Conclusion:Patients with full-thickness chondral flaps at the time of hip arthroscopy experienced greater improvements in functional outcome scores at the 12-month follow-up when treated with BMAC as opposed to microfracture.

Joint Preservation Using Orthobiologic Therapies in Osteoarthritis

Osteoarthritis is estimated to be the most prevalent musculoskeletal disorder in the world. Estimates show that the disease is prevalent in 18% and 10% in women and men that are aged &gt;60 years old. The quality of life of the affected patients can also be significantly impacted due to the associated morbidities and functional loss. Many interventions have been proposed to preserve the joint and enhance the functional outcomes in patients with osteoarthritis. In the present literature review, we have discussed the different orthobiologic therapies for patients with osteoarthritis for joint preservation and subsequent improvement in the functional and pain outcomes. Variable modalities that have been proposed in the literature include Bone Marrow Aspirate Concentrate (BMAC), gene therapy and platelet rich plasma (PRP). All of these modalities were reported with favorable outcomes and minimal complications. PRP has been reported to have a clinical efficacy that is boosed when co-administered with hyaluronic acid. However, it should be noted that the clinical efficacy is limited in the long term, and administration is continuously required. On the other hand, gene therapy is a promising technique that offers maintained favorable outcomes with no adverse events. However, further studies are still needed to indicate the effectiveness and cost-efficacy of this approach.

Outcomes of Autologous Osteochondral Transplantation With and Without Extracellular Matrix Cartilage Allograft Augmentation for Osteochondral Lesions of the Talus

Background: Autologous osteochondral transplantation (AOT) using a cylindrical graft in the treatment of osteochondral lesions of the talus (OLTs) is typically indicated for patients with larger lesions. However, with lesions that are irregular in shape, the AOT graft may not completely replace the lesion. For these lesions, we utilize extracellular matrix cartilage allograft (EMCA) augmentation in AOT to act as a physiologic grout at the host-graft interface. Purpose: To determine if the combination of EMCA with concentrated bone marrow aspirate (CBMA) would improve integration of the host-graft interface and subsequently reduce postoperative cyst formation after AOT. It was also hypothesized that EMCA in conjunction with CBMA would demonstrate improved MOCART (magnetic resonance observation of cartilage repair tissue) scores and functional outcome scores at a minimum 2 years after surgery. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective analysis was performed comparing patients treated with AOT/CBMA alone and AOT with CBMA/EMCA. Clinical outcomes were evaluated with the Foot and Ankle Outcome Score. Magnetic resonance imaging appearance was evaluated with the use of the MOCART (magnetic resonance observation of cartilage repair tissue) score. Cyst formation was also evaluated on postoperative magnetic resonance imaging. Results: A total of 26 patients were included in the AOT + CBMA/EMCA group (10 male, 16 female), and 34 patients were included in the AOT/CBMA group (17 male, 17 female). The mean Foot and Ankle Outcome Score significantly improved in both groups (P < .001) across all subscales (symptoms, pain, activities of daily living, sports activities, and quality of life), but there was no significant difference between groups at final follow-up. There was no significant difference in mean MOCART scores between the groups (P = .118). In the AOT/CBMA group, 3 patients (8.8%) complained of knee pain, and 1 (2.9%) required additional surgery (hardware removal). In the AOT + CBMA/EMCA group, 2 patients (7.7%) complained of knee pain, and 6 patients (23%) required additional surgery (3 hardware removals and 3 arthroscopic debridements of scar tissue in the ankle). Conclusion: We found that while EMCA with CBMA has benefit in regeneration and repair of OLT treated with bone marrow stimulation, there appears to be little benefit of EMCA over CBMA alone as a physiologic grout at the graft-host interface in OLT treated with AOT.