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. 2025 Jun 14;60(2):s00441800942.
doi: 10.1055/s-0044-1800942. eCollection 2025 Apr.

Effects of Intra-articular Bone Marrow Aspirate Infiltration in the Treatment of Knee Osteoarthritis: A Clinical Study Comparing BMA versus Corticosteroid and Genicular Block

Renata Clazzer  1 , Dilamar Moreira Pinto  1 , Mariana Valois de Aquino Krause  1 , Tale Lucas Vieira Rolim  1 , Ricardo Lyra de Oliveira  1 , Diego Ariel de Lima  2
Affiliations

Effects of Intra-articular Bone Marrow Aspirate Infiltration in the Treatment of Knee Osteoarthritis: A Clinical Study Comparing BMA versus Corticosteroid and Genicular Block

Renata Clazzer et al. Rev Bras Ortop (Sao Paulo). .

Abstract
in English, Portuguese

Objective To assess the efficacy of autologous bone marrow aspirate (BMA) in reducing pain and improving functionality in patients with knee osteoarthritis (OA), in comparison with intraarticular corticosteroid injection and genicular nerve block. Methods A prospective, randomized, controlled, single-blinded, comparative, and analytical clinical study was conducted. There were 50 patients with knee OA divided into two groups: an intervention group receiving BMA treatment and a control group undergoing standard corticosteroid articular infiltration and genicular block. Outcome measures were evaluated using the Western Ontario and McMaster universities osteoarthritis index (WOMAC). Results After 6 months, significant pain reduction was noted in the BMA group compared with the control group ( p = 0.030). No significant differences were found in stiffness and physical activity scores between the groups. The intervention group demonstrated significant improvements in all assessed WOMAC subcategories pre- and posttreatment. Conclusions Treatment with BMA can significantly reduce pain, potentially leading to an improved functionality, suggesting its potential as a viable therapeutic option for managing knee OA.

Objetivo Avaliar a eficácia do aspirado de medula óssea autólogo (BMA) na redução da dor e melhoria da funcionalidade em pacientes com osteoartrite (OA) de joelho, comparando com a infiltração intra-articular com corticoide e bloqueio genicular. Métodos Foi conduzido um estudo clínico prospectivo, randomizado, controlado, simples-cego, comparativo e analítico. Foram 50 pacientes com osteoartrite de joelho, divididos em dois grupos: um grupo de intervenção recebendo tratamento com BMA e um grupo controle submetido à infiltração articular padrão com corticoide e bloqueio genicular. Os resultados foram avaliados usando o Índice de Osteoartrite das Universidades de Western Ontario e McMaster (WOMAC). Resultados Após 6 meses, uma redução significativa da dor foi observada no grupo BMA em comparação ao grupo controle ( p = 0.030). Não foram encontradas diferenças significativas nos escores de rigidez e atividade física entre os grupos. O grupo de intervenção demonstrou melhorias significativas em todas as subcategorias do WOMAC avaliadas antes e após o tratamento. Conclusão O tratamento com BMA pode reduzir significativamente a dor, possibilitando uma possível melhora funcional, sugerindo seu potencial como uma opção terapêutica viável no manejo da OA de joelho.

Keywords: bone marrow; injections, intra-articular; osteoarthritis, knee; pain management.

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Conflict of interest statement

Conflict of Interests The authors have no conflict of interests to declare.

Figures

Fig. 1
Fig. 1
Bone marrow aspirate (BMA). ( A ) Puncture at the iliac crest near the anterior superior iliac spine, with a 40° inclination from lateral to medial and 40°o from superior to inferior. ( B ) The needle can be withdrawn and reinserted with a slight change in angulation to aspirate bone marrow from another site, which may improve the concentration of MSCs.
Fig. 2
Fig. 2
Bone marrow aspirate (BMA). ( A ) Schematic figure showing the ultrasound probe transversely aligned with the iliac bone. ( B ) Patient image showing the ultrasound probe transversely aligned with the iliac bone. ( C ) Ultrasound image corresponding to the position of the ultrasound probe transversely aligned with the iliac bone. ( D ) By rotating the probe 90°, the ultrasound image corresponding to the position of the ultrasound probe longitudinally aligned with the iliac bone. Red arrow, Iliac puncture site; white arrows, iliac cortical bone.
Fig. 3
Fig. 3
Anatomical landmarks for the lateral superior genicular nerve (LSGN) block. ( A ) Transducer in the coronal plane at the distal lateral metaphyseal region of the femur. ( B ) Ultrasound image obtained with the transducer in the coronal plane at the distal lateral metaphyseal region of the femur. ( C ) Schematic image in the coronal plane at the distal lateral metaphyseal region of the femur. White arrow and *, lateral superior genicular nerve; white circle, lateral superior genicular vein and artery.
Fig. 4
Fig. 4
Anatomical landmarks for the medial superior genicular nerve (MSGN) block. ( A ) Schematic image in the coronal plane at the distal medial metaphyseal region of the femur. ( B ) Ultrasound image obtained with the transducer in the coronal plane at the distal medial metaphyseal region of the femur. ( C ) Transducer in the coronal plane at the distal medial metaphyseal region of the femur. *Medial superior genicular nerve; white circle, medial superior genicular vein and artery.
Fig. 5
Fig. 5
Anatomical landmarks for the medial inferior genicular nerve (MIGN) block. ( A ) Schematic image in the coronal plane at the proximal medial metaphyseal region of the tibia. ( B ) Ultrasound image obtained with the transducer in the coronal plane at the proximal medial metaphyseal region of the tibia. ( C ) Transducer in the coronal plane at the proximal medial metaphyseal region of the tibia. *Medial inferior genicular nerve; white circle, medial inferior genicular vein and artery. Abbreviation: MCL, medial collateral ligament.
Fig. 6
Fig. 6
Group 1 (Intervention), BMA treatment. ( A ) BMA from the anterosuperior iliac spine using heparinized syringes. ( B ) Approximately 15 ml of bone marrow. ( C ) A 20 ml solution was prepared consisting of 8 ml of ropivacaine (10 mg/ml), 10 ml of 50% dextrose, and 2 ml of dexamethasone (4 mg/2.5 ml). This solution was used for genicular branch blocks, guided by ultrasound. From it, 5 ml each were applied to the medial femoral, lateral femoral, and medial tibial genicular branches. ( D ) The remaining 5 ml of the previous solution (ropivacaine + dextrose + dexamethasone) were mixed with the 15 ml of BMA and intraarticularly infiltrated into the knee in question.
Fig. 7
Fig. 7
WOMAC – Pain (BMA vs. Control). Scores between the two groups at each of the four evaluation times (preintervention, and at 1, 3, and 6-months posttreatment). This subsection assesses the intensity of pain during various activities, such as walking, climbing stairs, lying down, and standing. The higher the score, the greater the severity of symptoms and patients' functional limitation. The p -value corresponds to the independent t -test between the two groups at each of the four evaluation times.
Fig. 8
Fig. 8
WOMAC – Total Scores (BMA vs. Control). The total scores between the two groups at each of the four evaluation times (preintervention, and at 1, 3, and 6 months posttreatment). The total score is the sum of the scores from the three subscales (Pain, Stiffness, and Physical Function). The higher the score, the greater the severity of symptoms and patients' functional limitation. The p -value corresponds to the independent t -test between the two groups at each of the four evaluation times.
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