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. 2024 May 9;58(7):894-904.
doi: 10.1007/s43465-024-01168-6. eCollection 2024 Jul.

Bone Marrow Aspirate Concentrate for Treatment of Primary Knee Osteoarthritis: A Prospective, Single-Center, Non-randomized Study with 2-Year Follow-Up

Madhan Jeyaraman  1   2   3   4 , Naveen Jeyaraman  1 , Swaminathan Ramasubramanian  5 , Rajni Ranjan  6 , Saurabh Kumar Jha  2   7 , Ashim Gupta  4   8   9   10
Affiliations

Bone Marrow Aspirate Concentrate for Treatment of Primary Knee Osteoarthritis: A Prospective, Single-Center, Non-randomized Study with 2-Year Follow-Up

Madhan Jeyaraman et al. Indian J Orthop. .

Abstract

Introduction: Knee osteoarthritis (OA) is a widespread, disabling condition with no intervention to fully restore cartilage or halt progression. Bone marrow aspirate concentrate (BMAC), an autologous product from bone marrow aspiration, has shown promise as a regenerative therapy due to its cell composition and chondrogenic effects. Our study aims to assess the functional outcomes, including pain, function, satisfaction, and complications post-BMAC injection in knee OA patients.

Materials and methods: In this prospective, single-center study, 63 patients with grade II-III knee OA (Kellgren-Lawrence (K-L) scale) unresponsive to conservative management underwent BMAC injection. The procedure involved bone marrow aspiration from the anterior iliac crest, processing to obtain a concentrate, followed by intra-articular injection. Patients were followed for 24 months, assessing outcomes using the Visual Analog Scale (VAS), International Knee Documentation Committee (IKDC) score, and MOCART 2.0 score.

Results: The cohort, with a slight female predominance and predominantly aged 41-50 years, majorly comprised K-L grade III OA patients. BMAC treatment resulted in significant improvements in VAS pain scores, IKDC functional scores, and MOCART 2.0 scores over the 24-month follow-up.

Conclusion: BMAC injection provides significant improvement in both pain and functional outcomes at mid-term follow-up in patients with mild-to-moderate OA of the knee. Further high-quality, adequately powered, multi-center, prospective, double-blinded, randomized controlled trials with longer follow-up are necessary to justify the routine clinical use of BMAC for treatment of patients suffering with knee OA.

Keywords: BMAC; Bone marrow aspirate; Bone marrow aspirate concentrate; Knee; Knee osteoarthritis; Regenerative medicine.

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Conflict of interest statement

Conflicts of InterestThe authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Aspiration of bone marrow from the right iliac crest
Fig. 2
Fig. 2
Intra-articular injection of BMAC via antero-superolateral portal into left knee joint
Fig. 3
Fig. 3
Schematic representation of BMAC isolation (created with Biorender.com)
Fig. 4
Fig. 4
VAS score at various follow-up time points compared to the baseline. *Represents p < 0.05 compared to baseline
Fig. 5
Fig. 5
IKDC score at various follow-up time points compared to the baseline. *Represents p < 0.05 compared to baseline
Fig. 6
Fig. 6
A Pre-procedural radiograph of bilateral knees (AP view on standing position) showing decreased medial joint line in bilateral knees suggestive of KL grade II knee OA and B 2-year follow-up radiograph of bilateral knees (AP view on standing position) showing the maintenance of medial joint line in bilateral knees indicating response to BMAC therapy
Fig. 7
Fig. 7
A Pre-procedural T2W MRI (coronal section) showing hyperintensity with thinned out cartilage along the medial femoral condyle suggestive of OA knee and B 2-year follow-up T2W MRI (coronal image) showing increased cartilaginous thickness with a relatively maintained cartilaginous signal indicating response to BMAC therapy
See this image and copyright information in PMC

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