What did the study look at?
Knee osteoarthritis is a painful condition with progressive changes in the cartilage and underlying bone. The authors note that total knee replacement has some limitations when performed at an early stage and a young age. Bone marrow aspirate concentrate (BMAC) is rich in mesenchymal stem cells. The study aimed to investigate the effectiveness of BMAC in terms of functional recovery in knee osteoarthritis.
How was it done?
- Fifty-two patients who received a BMAC injection for symptomatic osteoarthritis of one knee between January 2015 and March 2017 were included (35 women, 17 men; mean age 59.2 ± 7.4 years).
- Patients with knee instability, severe malalignment, a flexion contracture over 10 degrees, blood disorders, inflammatory arthritis, immune deficiency, cancer, active infection or symptoms in both knees were excluded.
- On the Kellgren-Lawrence scale, osteoarthritis was grade 2 in 13 patients (25%), grade 3 in 28 (53.8%) and grade 4 in 11 (21.2%).
- Under local anaesthetic, 60 cc of bone marrow was taken from the front of the pelvic bone, concentrated with a commercial centrifuge kit, and 5-7 cc of concentrate was injected into the knee in a single session.
- Function was measured before treatment and at 6, 12 and 24 months with the Lysholm and Modified Cincinnati scores. The mean follow-up was 22.1 ± 3.6 months.
What did it find?
- The mean Lysholm score rose from 56.6 before treatment to 84.5 at 6 months and 86.2 at 12 months; at 24 months (41 patients) it was 81.6.
- The Cincinnati score rose from 54.7 to 84.3 at 6 months, and was 83.7 at 12 months and 79.9 at 24 months.
- Scores were significantly higher than before treatment at every follow-up (p = 0.0001), but a significant drop was observed after 12 months.
- There were no significant differences by sex, side or body mass index group (p > 0.05).
- Patients with Kellgren-Lawrence grade 4 osteoarthritis had significantly lower scores than those with grades 2 and 3 (p = 0.004 for Lysholm, p = 0.001 for Cincinnati).
The authors' conclusion
The authors state that, considering functional results up to two years, BMAC application was observed to provide functional recovery in knee osteoarthritis. They emphasise that further studies are needed to determine its effectiveness and long-term outcomes in advanced knee osteoarthritis.
Limitations
According to the authors, the most important limitation is the lack of a control group. They state that randomised controlled studies with longer follow-up and more patients are needed.
Reference
Gürsoy S, Akkaya M, Şimşek ME, Bozkurt M. (2019). Functional outcomes of bone marrow aspirate concentrate application in osteoarthritis of the knee. International Journal of Research in Medical Sciences, 7(2), 587–592. Licence: Creative Commons Attribution Non-Commercial (CC BY-NC).
DOI: 10.18203/2320-6012.ijrms20190076
Free full text: msjonline.org (PDF)
This article summarises a published scientific paper for general information; it does not replace an examination or a personal medical assessment. Please consult your doctor about your symptoms.
