Bone Marrow Aspirate Concentrate Is More Effective Than Hyaluronic Acid and Autologous Conditioned Serum in the Treatment of Knee Osteoarthritis: A Retrospective Study of 505 Consecutive Patients

Abstract

The aim of this study was to evaluate and compare the effectiveness of three different intra-articular injective treatments: hyaluronic acid (HA), autologous conditioned serum (ACS) and bone marrow aspirate concentrate (BMAC) for the treatment of knee osteoarthritis (OA). A Level III retrospective comparative clinical study was performed on 505 consecutive patients treated with HA (n = 171), ACS (n = 222) or BMAC (n = 112) for knee OA. The mean patient age was 52 ± 13 years; 54.5% were males. Collected data included patient demographics, symptoms, visual analogue scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and radiographic classification of osteoarthritis grade using plain radiographs and advanced imaging. Clinical outcome was assessed at 3 and 12 months post treatment. Significant improvement in VAS and WOMAC was seen for all three treatments at the 3-month follow-up. At 12 months, VAS was improved in all three treatment groups, yet only BMAC sustained the improved WOMAC even in patients with more severe degenerative changes. This study shows that BMAC is more effective than HA and ACS in the treatment of symptomatic knee OA, especially in the patients with more severe degenerative changes.

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

“…Various studies have shown excellent clinical and functional outcomes with single dose or multiple doses of BMAC ranging from 4 to 12 mL per knee for cartilage regeneration [ 30 , 119 , 122 , 123 , 124 , 126 ]. A single dose of 8 mL BMAC demonstrated a superior clinical outcome than PRP and autologous conditioned serum in the patients with OA knee [ 12 ]. However, it has now been established that it is not the volume of delivery that matters but it is the count of active cellular components in the vehicle used for delivery that brings about a significant change in the perceived outcome [ 119 ].…”

“…BM also contains other multipotent cells, such as hematopoietic stem cells and vascular progenitors, which are likely to play a substantial role in the repair of damaged tissues. Various forms of clinical evidence exist to demonstrate the safety and efficacy of bone marrow-derived MSCs in an osteoarthritic (OA) knee [ 9 , 10 , 11 , 12 , 13 ]. The application of BMAC has been expanded to other indications such as a partial tear of ACL [ 14 ], meniscus injuries [ 15 ], tendon pathologies [ 16 ], bone defect in the form of delayed or non-union of fractures [ 17 , 18 ], chondral and osteochondral defects [ 19 ], and patellofemoral arthritis [ 3 ].…”

“…Being a minimally invasive procedure, it is tolerated well by patients with better compliance with the post-procedural rehabilitation program. The short- and long-term results of BMAC in cartilage regeneration are encouraging with good to excellent clinical, functional, radiological outcomes [ 10 , 12 , 13 ]. No major adverse effects were reported with BMAC therapy except for donor site pain [ 26 ].…”

“…Keeling et al demonstrated improvement in pain and patient-reported outcomes in OA knee patients with BMAC injections at short- to mid-term follow-up. In severe degenerative arthritis, BMAC has shown clinical benefits compared to PRP and hyaluronate [ 12 ]. In a 5-year follow-up study, intra-articular BMAC injection has proven clinical benefits in K-L grade 1 and 2 osteoarthritis knees [ 41 ].…”

Short-Term Efficacy of Using a Novel Low-Volume Bone Marrow Aspiration Technique to Treat Knee Osteoarthritis: A Retrospective Cohort Study

“…Toward this end, a variety of studies have examined the use of orthobiologics to treat knee OA [12,[14][15][16][17]. In particular, a number of studies have examined the ability of bone marrow concentrates (BMC) to treat OA [18][19][20][21][22][23]. Bone marrow contains mesenchymal stem cells (MSCs), platelets, and monocytes, all of which may contribute to improvements within the joint [24,25].…”