Biological Effects of Bone Marrow Concentrate in Knee Pathologies

Abstract

With our aging population desiring to remain active, the incidence and costs associated with managing knee pain from both acute injury and symptomatic knee osteoarthritis continue to dramatically increase. Current treatment methods fall short with respect to their ability to improve the intra-articular environment and restore normal joint homeostasis. With increasing basic science and clinical evidence showing efficacy, cell-based therapies such as bone marrow concentrate (BMC) hold promise as a nonsurgical joint preserving treatment approach. BMC has inherent advantages over other treatments commonly used for various knee pathologies because it is a point-of-care orthobiologic product that uniquely and simultaneously delivers growth factors, anti-inflammatory proteins, and mesenchymal stem cells. There is increasing evidence for the use of BMC for repair of focal cartilage defects and for the treatment of generalized knee pain. However, continued high-quality studies are necessary for the clinical utility of BMC to be critically assessed with particular attention paid to appropriate patient selection, standardized aspiration, and processing and reporting of both functional and imaging-based outcomes.

Bone marrow concentrate injections for the treatment of osteoarthritis: evidence from preclinical findings to the clinical application

“…These growth factors are involved in several pathways crucial for cell maintenance and function, for differentiation, for extracellular matrix production, and for the regulation of cell catabolic/anabolic activity [56][57][58]. Accordingly, this combination of cells and bioactive proteins makes BMAC a unique product among the orthobiologics presently available, and may present the potential to alter the disease course and not just to decrease pain [59]. Beside this rationale, the increasing use of BMAC is also due to the severe restrictions and regulatory issues related to other strategies to exploit MSCs, which involve extended cell manipulation and in vitro cultivation.…”

Bone Marrow Concentrate Mesenchymal Stromal Cells Do not Correlate With Nucleated Cell Count or Colony Forming Units

“…Bone marrow aspirate concentrate (BMC) is generated by centrifugation of bone marrow aspirate and is used as a point-of-care biologic to address several musculoskeletal injuries. 1 It has been reported as a successful treatment alone or in combination with a scaffold for full thickness cartilage loss, 2-4 osteoarthritis [5][6][7] and osteochondral lesions. [8][9][10] Like all orthobiologics, there is an inherent heterogeneity in BMC preparations due to patient variability and differences between company devices, making it difficult to define what components in BMC affect clinical outcome.…”