Bone Marrow Aspirate Concentrate Is Equivalent to Platelet-Rich Plasma for the Treatment of Knee Osteoarthritis at 1 Year: A Prospective, Randomized Trial

Abstract

Background: Approximately 47 million people in the United States have been diagnosed with arthritis. Autologous platelet-rich plasma (PRP) injections have been documented to alleviate symptoms related to knee osteoarthritis (OA) in randomized controlled trials, systematic reviews, and meta-analyses. Autologous bone marrow aspirate concentrate (BMC) injections have also emerged as a treatment option for knee OA, with a limited clinical evidence base. Purpose: To compare the efficacy of BMC to PRP for the treatment of knee OA regarding pain and function at multiple time points up to 12 months after an injection. We hypothesized that BMC will be more effective in improving outcomes in patients with knee OA. Study Design: Randomized controlled trial; Level of evidence, 2 Methods: A total of 90 participants aged between 18 and 80 years with symptomatic knee OA (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) questionnaires before and 1, 3, 6, 9, and 12 months after a single intra-articular injection of leukocyte-rich PRP or BMC. Results: There were no statistically significant differences in baseline IKDC or WOMAC scores between the 2 groups. All IKDC and WOMAC scores for both the PRP and BMC groups significantly improved from baseline to 1 month after the injection ( P < .001). These improvements were sustained for 12 months after the injection, with no difference between PRP and BMC at any time point. Conclusion: Both PRP and BMC were effective in improving patient-reported outcomes in patients with mild to moderate knee OA for at least 12 months; neither treatment provided a superior clinical benefit. Autologous PRP and BMC showed promising clinical potential as therapeutic agents for the treatment of OA, and while PRP has strong clinical evidence to support its efficacy, BMC has limited support. This study did not prove BMC to be superior to PRP, providing guidance to clinicians treating OA. It is possible that the results were affected by patients knowing that there was no control group. Registration: NCT03289416 ( ClinicalTrials.gov identifier).

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

“…However, five studies were excluded being congress abstracts, one study was excluded because it was a case report [25], and one study was excluded because it provided the same data of another included study [26]. Thus, a total of 22 studies were included in the qualitative data synthesis: 4 preclinical studies [27][28][29][30] and 18 clinical studies [31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48]. Since the first reports in 2014, the publication trend remarkably increased over time, especially for the clinical studies, with over 50% of the articles published from 2018 ( Fig.…”

“…Out of the 18 clinical articles found (Table 2), six were retrospective case series, five were retrospective comparative studies, four were randomized controlled trials (RCTs), and three were prospective case series. Eleven studies focused on knee OA [31][32][33][34][35][36][37][38][39][40][41], two focused on hip OA [42,43], two focused on shoulder OA [44,45], while the other three studies described several joints affected by OA [46][47][48]. Intra-articular BMAC injections were performed in 17 studies, while in one study [36], the injection was performed within the tibial and femoral subchondral bone of the knee.…”

Editorial Commentary: Human Granulocyte-Stimulating Factor Increases the Leukocyte Richness of Platelet-Rich Plasma

“…O rthobiologics, which include platelet-rich plasma (PRP), bone marrow aspirate (BMA) and concentrate (cBMA), fat grafting, and mesenchymal stem cells (MSCs), are being used increasingly in musculoskeletal diseases such as osteoarthritis and acute/chronic injury of tendon, ligament, and muscle. [1][2][3][4][5][6] PRP, which is the most common treatment in orthobiologics, is an autologous blood product that concentrates platelets and contains multiple growth factors and cytokines. 7,8 PRP therapy is safe, low cost, and minimally invasive and could be used to promote the tissue-repair process.…”

Bone Marrow Aspirate Concentrate Is Equivalent to PRP for the Treatment of Knee OA at 1 Year: Letter to the Editor

“…It was with great interest that we reviewed the article by Anz et al 1 published in the Orthopaedic Journal of Sports Medicine entitled “Bone Marrow Aspirate Concentrate Is Equivalent to Platelet-Rich Plasma for the Treatment of Knee Osteoarthritis at 1 Year: A Prospective, Randomized Trial.” There are numerous concerns regarding most especially the title and conclusions of this manuscript. Both the title and the conclusions would suggest concentrate offers no additional benefits for knee osteoarthritis over standard platelet-rich plasma (PRP).…”

“…2 –4,6,7,9 This technique stresses the importance of using low-volume aspiration using small syringes. 2 In this case, two 30-mL syringes were used from a same single point using what is described as “a traditional 11-gauge, 11-cm Jamshidi needle (Renfrac).” 1 The methods section further describes a technique of “withdrawing and rotating the needle.” 1 This is not a method that most clinicians using bone marrow would recommend to optimally obtain a proper bone marrow aspirate.…”