Neither Bone Marrow Aspirate Concentrate nor Platelet-Rich Plasma Improves Patient-Reported Outcomes After Surgical Management of Acetabular Labral Tears; However, Bone Marrow Aspirate Concentrate May Be Effective for Moderate Cartilage Damage: A Systematic Review

Abstract

Purpose: To (1) systematically assess which orthobiologic agents are being used in acetabular labral repairs and (2) report all available outcomes for patients undergoing operative management for labral repairs with orthobiologic agents.

Methods: The PubMed, Embase, and Cochrane databases were queried in August 2023. Articles were included if they used an orthobiologic agent during hip arthroscopy for acetabular labral repair and reported functional outcomes. Each study was queried for demographic data, orthobiologic agent used, volume of agent used, imaging modality used to guide administration, follow-up period, and all reported outcomes. The following Boolean phrase was used to systematically search the current literature: ((Orthobiologics) OR (Platelet-rich plasma) OR (PRP) OR (Mesenchymal stem cells) OR (MSCs) OR (Hyaluronic acid) OR (Growth factors) OR (bone marrow aspirate) OR (BMAC)) AND (hip joint OR (acetabular labrum) OR (Chondrolabr∗ damage) OR (Chondrolabr∗ tear)) AND (outcome∗ OR function∗ OR PROM OR PRO OR arthr∗ OR image OR pain OR complication).

Results: Three studies met the inclusion criteria and included 201 patients who received treatment with orthobiologic agents. Of these patients, 119 (59.7%) were women, with age ranging from 35 to 49 years. Ninety-seven patients (48.3%) received bone marrow aspirate concentrate (BMAC), and 104 (51.7%) received platelet-rich plasma (PRP). Both BMAC studies showed no significant improvements compared with controls; however, a subanalysis limited to patients with moderate cartilage damage who received BMAC showed significantly improved 2-year patient-reported outcome measures (International Hip Outcome Tool 33 score, 82.5 vs 69.5; P = .03). The one PRP study did not show significant improvements compared with controls. No complications were noted after either PRP or BMAC harvesting and application in any included study.

Conclusions: Overall, BMAC and PRP do not significantly improve patient-reported outcome measures compared with controls. However, there is limited evidence that BMAC may help patients with moderate cartilage damage.

Level of evidence: Level III, systematic review of Level II and III studies.

Fig 1

Preferred Reporting Items for Systematic Reviews and Meta-analyses diagram depicting study selection process. A review of the literature was performed using the PubMed, Embase, and Cochrane databases in August 2023. The goal was to identify studies investigating the use of any orthobiologic agent as an adjuvant treatment in the surgical management of acetabular labral tears.

Fig 2

Methodological Index for Non-randomized Studies scoring system. This ranking system was used to rigorously assess publication bias among the included studies.