Bone Marrow Aspirate Concentrate Is Equivalent to Platelet-Rich Plasma for the Treatment of Knee Osteoarthritis at 2 Years: A Prospective Randomized Trial

Abstract

Background: Autologous platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMC) are being used clinically as therapeutic agents for the treatment of knee osteoarthritis. Purpose/Hypothesis: The purpose of this study was to compare the efficacy of BMC and PRP on pain and function in patients with knee osteoarthritis up to 24 months after injection. It was hypothesized that patients receiving BMC would have better sustained outcomes than those receiving PRP. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: A total of 90 participants aged between 18 and 80 years with symptomatic knee osteoarthritis (Kellgren-Lawrence grades 1-3) were randomized into 2 study groups: PRP and BMC. Both groups completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and subjective International Knee Documentation Committee (IKDC) questionnaire before and 1, 3, 6, 9, 12, 18, and 24 months after a single intra-articular injection of leukocyte-rich PRP or BMC. A linear mixed-effects model was performed to quantify the effects over time and the difference between the groups. This model has the random effect for time to assess the extent in which the change over time differs from one person to another. Results: An overall 84 patients completed questionnaires from baseline to 12 months; however, 17 patients (n = 9; PRP group) were lost to follow-up at 18 months and 25 (n = 13; PRP group) at 24 months. There were no statistically significant differences in IKDC ( P = .909; 95% CI, −6.26 to 7.03) or WOMAC ( P = .789; 95% CI, −6.26 to 4.77) scores over time between the groups. Both groups had significantly improved IKDC ( P < .001; 95% CI, 0.275-0.596) and WOMAC ( P = .001; 95% CI, −0.41 to −0.13) scores from baseline to 24 months after the injection. These improvements plateaued at 3 months and were sustained for 24 months after the injection, with no difference between PRP and BMC at any time point. Conclusions: For the treatment of osteoarthritis, PRP and BMC performed similarly out to 24 months. BMC was not superior to PRP. Registration: NCT03289416 (ClincalTrials.gov identifier).

Research trends of platelet-rich plasma therapy on knee osteoarthritis from 2011 to 2021: A review

“…[ 42 ] In addition, studies have shown that bone marrow aspirate concentrate, which contains a relatively low percentage of MSCs, is not statistically different in terms of pain relief, functional improvement, and occurrence of adverse events compared to PRP in patients with KOA treated by injection. [ 43 , 44 ]…”

“…[42] In addition, studies have shown that bone marrow aspirate concentrate, which contains a relatively low percentage of MSCs, is not statistically different in terms of pain relief, functional improvement, and occurrence of adverse events compared to PRP in patients with KOA treated by injection. [43,44] Figure 7 shows the top 10 strongest keyword bursts from 2011 to 2021. a randomized controlled trial is the most important study method to evaluate PRP for KOA. the Chondrogenic differentiation burst appeared in 2012 and ended in 2015 in the second place.…”

Stem cells for the treatment of early to moderate osteoarthritis of the knee: a systematic review

“…All the included studies used autologous-derived MSCs. Seven studies used MSCs provided by the abdominal adipose tissue [ 1 , 10 , 21 , 27 – 29 ], four used bone marrow from the iliac crest [ 2 , 7 , 22 , 24 ], and one from both sources [ 3 ]. Different reported devices were used for harvesting adipose or bone marrow-derived MSCs (Celution, Lipogems, Lipocell, GID SVF-2, PureBMC) [ 2 , 8 , 10 , 21 , 27 , 28 ].…”

Microfragmented Adipose Tissue Is Equivalent to Platelet-Rich Plasma for Knee Osteoarthritis at 12 Months Posttreatment: A Randomized Controlled Trial

“…16 , 17 , 27 However, despite the plausible rationale for using these cells, so far neither BMAC nor MFAT has outperformed PRP for knee OA in a randomized trial. 2 , 3 , 20 , 29 This is important because these latter techniques are more invasive and expensive than PRP. Although BMAC and MFAT may have utility in OA care that needs elucidation, the clinical outcomes, risk, and cost all favor PRP.…”