A REVIEW OF BONE MARROW ASPIRATE CONCENTRATE THERAPY IN THE TREATMENT OF KNEE OSTEOARTHRITIS
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Keywords
Regenerative Medicine, Knee Osteoarthritis, Bone marrow aspirate, Mesenchymal Stem Cells, Regenerative Medicine, Orthobiologics, Platelet Rich Plasma, Stem Cells, Osteoarthritis, Intra-Articular Injection
Abstract
Purpose: Bone marrow aspirate concentrate (BMAC) provides a novel therapeutic option for knee osteoarthritis. The authors aim to systematically evaluate functional and clinical outcomes after BMAC injection treatment for knee osteoarthritis.
Methods: We used articles found in PubMed and Google Scholar using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies published from January 2018 through November 2023 on patients treated with a bone marrow aspirate concentrate injection with a focus on grades I-IV Kellgren-Lawrence osteoarthritis of the knee. Reports contained functional and clinical outcomes.
Results: Eleven articles were used in the extraction of data. Eight hundred seventy-six patients were injected with BMAC and 1,010 knees with osteoarthritis were included in this literature review. For studies that passed inclusion and exclusion criteria, reported outcomes included improved pain, function, and quality of life post-procedure.
Conclusion: The literature reviewed indicates that the intraarticular injection of BMAC warrants additional investigation in treating mild to severe osteoarthritis (classified under Kellgren-Lawrence I-IV). Factors such as the preparation and concentration of BMAC remain subjects of ongoing debate and scrutiny. Consequently, further research is needed to determine the feasibility and effectiveness of BMAC as a treatment modality for knee osteoarthritis.
Level of Evidence: IV.
References
2. Ding JB, Hu K. Injectable therapies for knee osteoarthritis. Reumatologia. 2021;59(5):330-339. doi: 10.5114/reum.2021.110612. Epub 2021 Nov 7. PMID: 34819708; PMCID: PMC8609383.
3. Ip HL, Nath DK, Sawleh SH, Kabir MH, Jahan N. Regenerative Medicine for Knee Osteoarthritis - The Efficacy and Safety of Intra-Articular Platelet-Rich Plasma and Mesenchymal Stem Cells Injections: A Literature Review. Cureus. 2020 Sep 21;12(9):e10575. doi: 10.7759/cureus.10575. PMID: 33101819; PMCID: PMC7577352.
4. Molnar V, Pavelić E, Vrdoljak K, Čemerin M, Klarić E, Matišić V, Bjelica R, Brlek P, Kovačić I, Tremolada C, Primorac D. Mesenchymal Stem Cell Mechanisms of Action and Clinical Effects in Osteoarthritis: A Narrative Review. Genes (Basel). 2022 May 26;13(6):949. doi: 10.3390/genes13060949. PMID: 35741711; PMCID: PMC9222975.
5. Bashekah KA, Zagzoug ME, Banaja AW, Alghamdi AA, Mishiming OS, Jan MA, Kemawi OA, Alharbi BA, Althagafi AA, Aljifri SM. Prevalence and Characteristics of Knee Osteoarthritis Among the General Public in Saudi Arabia. Cureus. 2023 Oct 25;15(10):e47666. doi: 10.7759/cureus.47666. PMID: 38021677; PMCID: PMC10670982.
6. Le H, Xu W, Zhuang X, Chang F, Wang Y, Ding J. Mesenchymal stem cells for cartilage regeneration. J Tissue Eng. 2020 Aug 26;11:2041731420943839. doi: 10.1177/2041731420943839. PMID: 32922718; PMCID: PMC7457700.
7. Huang R, Li W, Zhao Y, Yang F, Xu M. Clinical efficacy and safety of stem cell therapy for knee osteoarthritis: A meta-analysis. Medicine (Baltimore). 2020 Mar;99(11):e19434. doi: 10.1097/MD.0000000000019434. PMID: 32176071; PMCID: PMC7220405.
8. Shang Z, Wanyan P, Zhang B, Wang M, Wang X. A systematic review, umbrella review, and quality assessment on clinical translation of stem cell therapy for knee osteoarthritis: Are we there yet? Stem Cell Res Ther. 2023 Apr 15;14(1):91. doi: 10.1186/s13287-023-03332-5. PMID: 37061744; PMCID: PMC10105961.
9. Kyriakidis T, Pitsilos C, Iosifidou M, Tzaveas A, Gigis I, Ditsios K, Iosifidis M. Stem cells for the treatment of early to moderate osteoarthritis of the knee: a systematic review. J Exp Orthop. 2023 Oct 7;10(1):102. doi: 10.1186/s40634-023-00665-1. PMID: 37804354; PMCID: PMC10560289.
10. Iijima, H., Isho, T., Kuroki, H. et al. Effectiveness of mesenchymal stem cells for treating patients with knee osteoarthritis: a meta-analysis toward the establishment of effective regenerative rehabilitation. npj Regen Med 3, 15 (2018). https://doi.org/10.1038/s41536-018-0041-8
11. Huang, Rui MDa; Li, Wei MDb; Zhao, Ying MDc; Yang, Fan MDd; Xu, Meng PhDe,∗. Clinical efficacy and safety of stem cell therapy for knee osteoarthritis: A meta-analysis. Medicine 99(11):p e19434, March 2020. | DOI: 10.1097/MD.0000000000019434
12. Page M J, McKenzie J E, Bossuyt P M, Boutron I, Hoffmann T C, Mulrow C D et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews BMJ 2021; 372 :n71 doi:10.1136/bmj.n71
13. Jeremy Howick, Iain Chalmers, Paul Glasziou, Trish Greenhalgh, Carl Heneghan, Alessandro Liberati, Ivan Moschetti, Bob Phillips, and Hazel Thornton. “Explanation of the 2011 Oxford Centre for Evidence-Based Medicine (OCEBM) Levels of Evidence (Table)”.
14. Dulic O, Rasovic P, Lalic I, et al. Bone Marrow Aspirate Concentrate versus Platelet Rich Plasma or Hyaluronic Acid for the Treatment of Knee Osteoarthritis. Medicina (Kaunas). 2021;57(11):1193. Published 2021 Nov 2. doi:10.3390/medicina57111193
15. El-Kadiry AE, Lumbao C, Salame N, Rafei M, Shammaa R. Bone marrow aspirate concentrate versus platelet-rich plasma for treating knee osteoarthritis: a one-year non-randomized retrospective comparative study. BMC Musculoskelet Disord. 2022;23(1):23. Published 2022 Jan 3. doi:10.1186/s12891-021-04910-5
16. Kuebler D, Schnee A, Moore L, et al. Short-Term Efficacy of Using a Novel Low-Volume Bone Marrow Aspiration Technique to Treat Knee Osteoarthritis: A Retrospective Cohort Study. Stem Cells Int. 2022;2022:5394441. Published 2022 Nov 15. doi:10.1155/2022/5394441
17. Kon E, Boffa A, Andriolo L, et al. Combined subchondral and intra-articular injections of bone marrow aspirate concentrate provide stable results up to 24 months. Knee Surg Sports Traumatol Arthrosc. 2023;31(6):2511-2517. doi:10.1007/s00167-022-07195-w
18. Rasovic P, Dulic O, Lalic I, et al. The role of osteoarthritis severity, BMI and age on clinical efficacy of bone marrow aspirate concentrate in the treatment of knee osteoarthritis. Regen Med. 2023;18(9):735-747. doi:10.2217/rme-2023-0042
19. Shaw B, Darrow M, Derian A. Short-Term Outcomes in Treatment of Knee Osteoarthritis With 4 Bone Marrow Concentrate Injections. Clin Med Insights Arthritis Musculoskelet Disord. 2018;11:1179544118781080. Published 2018 Jun 18. doi:10.1177/1179544118781080
20. Smith AD, Sydora D, Burnham R. Derivation of a clinical decision rule for a bone marrow aspirate concentrate injection in knee osteoarthritis. Regen Med. 2023;18(6):461-470. doi:10.2217/rme-2023-0014
21. Goncars V, Kalnberzs K, Jakobsons E, et al. Treatment of Knee Osteoarthritis with Bone Marrow-Derived Mononuclear Cell Injection: 12-Month Follow-up. Cartilage. 2019;10(1):26-35. doi:10.1177/1947603517746721
22. Mariani C, Meneghetti E, Zambon D, Elena N, Agueci A, Melchior C. Use of bone marrow derived mesenchymal stem cells for the treatment of osteoarthritis: A retrospective long-term follow-up study. J Clin Orthop Trauma. 2022;36:102084. Published 2022 Dec 5. doi:10.1016/j.jcot.2022.102084
23. Themistocleous GS, Chloros GD, Kyrantzoulis IM, et al. Effectiveness of a single intra-articular bone marrow aspirate concentrate (BMAC) injection in patients with grade 3 and 4 knee osteoarthritis. Heliyon. 2018;4(10):e00871. Published 2018 Oct 18. doi:10.1016/j.heliyon.2018.e00871
24. Vitali M, Ometti M, Pironti P, et al. Clinical and functional evaluation of bone marrow aspirate concentrate vs autologous conditioned serum in the treatment of knee osteoarthritis. Acta Biomed. 2022;93(5):e2022222. Published 2022 Oct 26. doi:10.23750/abm.v93i5.12845
25. Maheshwer, Bhargavi, et al. “Regenerative potential of mesenchymal stem cells for the treatment of knee osteoarthritis and chondral defects: A systematic review and meta-analysis.” Arthroscopy: The Journal of Arthroscopic & Related Surgery, vol. 37, no. 1, Jan. 2021, pp. 362–378, https://doi.org/10.1016/j.arthro.2020.05.037.
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