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Review
. 2024 Oct 11:62:36-42.
doi: 10.1016/j.jor.2024.10.005. eCollection 2025 Apr.

Complication rates of bone marrow aspirate concentrate injections versus other injectable therapies for knee osteoarthritis: A systematic review and meta-analysis

Stephen Fucaloro  1 , Jack T Bragg  1 , Matthew W Feldman  2 , Laura Krivicich  1 , Matthew J Salzler  1
Affiliations
Review

Complication rates of bone marrow aspirate concentrate injections versus other injectable therapies for knee osteoarthritis: A systematic review and meta-analysis

Stephen Fucaloro et al. J Orthop. .

Abstract

Background: Complications of bone marrow aspirate concentrate (BMAC) injections for knee osteoarthritis (OA) are not well known and were investigated through comparison to other injections.

Methods: PubMed, Embase, Cochrane, and Web of Science databases were searched for randomized controlled trials (RCTs) comparing isolated BMAC injections to other injectables for knee OA. Demographics, complications, and comparator injectable treatments were collected. Complication rates and number needed to harm (NNH) were calculated for BMAC. DerSimonian-Laird random-effects models evaluated differences in pooled early (≤7 days) and late (>7 days) complication rates using odds ratios.

Results: Six RCTs were identified with 860 patients, 334 of whom received BMAC injections. The mean follow-up was 13 months. The overall complication rates among BMAC and comparison groups were 41.91 % and 41.25 %, respectively (p = 0.85). The NNH for BMAC was 152. Knee effusion was the most common complication of BMAC (18.26 %). Early and late complication rates for BMAC were not significantly different from other injectables (hyaluronic acid [HA], steroids, platelet-rich plasma, stromal vascular fraction, mesenchymal stromal cells, or saline) (early p = 0.09, I 2 = 0; late p = 0.46, I 2 = 0), nor specifically compared to HA (early p = 0.76, I 2 = 0; late p = 0.66, I 2 = 0).

Conclusions: Complication rates of BMAC injections are not significantly different from other injectables, nor specifically from HA for knee OA. Compared to other injections, 152 patients would need to receive a BMAC injection for one additional patient to experience a complication.

Keywords: BMAC; Bone marrow aspirate concentrate; Complications; Injection; Knee osteoarthritis.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Associate Editor for Arthroscopy. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

References

    1. Bolia I.K., Bougioukli S., Hill W.J., et al. Clinical efficacy of bone marrow aspirate concentrate versus stromal vascular fraction injection in patients with knee osteoarthritis: a systematic review and meta-analysis. Am J Sports Med. 2022;50(5):1451–1461. doi: 10.1177/03635465211014500. - DOI - PubMed
    1. Alkan B.M., Fidan F., Tosun A., Ardıçoğlu O. Quality of life and self-reported disability in patients with knee osteoarthritis. Mod Rheumatol. 2014 Jan;24(1):166–171. doi: 10.3109/14397595.2013.854046. PMID: 24261774. - DOI - PubMed
    1. Cottom J.M., Plemmons B.S. Bone marrow aspirate concentrate and its uses in the foot and ankle. Clin Podiatr Med Surg. 2018;35(1):19–26. doi: 10.1016/j.cpm.2017.08.006. - DOI - PubMed
    1. Keeling L.E., Belk J.W., Kraeutler M.J., et al. Bone marrow aspirate concentrate for the treatment of knee osteoarthritis: a systematic review. Am J Sports Med. 2022;50(8):2315–2323. doi: 10.1177/03635465211018837. - DOI - PubMed
    1. Imam M.A., Holton J., Horriat S., et al. A systematic review of the concept and clinical applications of bone marrow aspirate concentrate in tendon pathology. Sicot j. 2017;3:58. doi: 10.1051/sicotj/2017039. - DOI - PMC - PubMed