Quantitative T2 MRI Mapping and 12-Month Follow-up in a Randomized, Blinded, Placebo Controlled Trial of Bone Marrow Aspiration and Concentration for Osteoarthritis of the Knees

Abstract

Objective Bone marrow aspiration and concentration (BMAC) is becoming a more common regenerative therapy for musculoskeletal pathology. In our current pilot study, we studied patients with mild-to-moderate bilateral knee osteoarthritis, compared pain at 12-month follow-up between BMAC-injected and saline-injected knees, and examined cartilage appearance measured by magnetic resonance imaging (MRI) T2 quantitative mapping. Design Twenty-five patients with mild-to-moderate bilateral osteoarthritic knee pain were randomized to receive BMAC into one knee and saline placebo into the other. Bone marrow was aspirated from the iliac crests, concentrated in an automated centrifuge, combined with platelet-poor plasma for knee injection, and compared with saline injection into the contralateral knee. Primary outcome measures were T2 MRI cartilage mapping at 6-month and Visual Analog Scale and Osteoarthritis Research Society International Intermittent and Constant Osteoarthritis Pain scores and radiographs at 12-month follow-up. Results Constant, intermittent, and overall knee pain remained significantly decreased from baseline at 12-month follow-up (all P ⩽ 0.01), with no apparent difference between BMAC- and saline-treated knees (all P ⩾ 0.54). A similar significant increase from baseline to 12-month follow-up regarding quality of life was observed for both BMAC- and saline-treated knees (all P ⩽ 0.04). T2 quantitative MRI mapping showed no significant changes as a result of treatment. Conclusions BMAC is safe to perform and relieves pain from knee arthritis but showed no superiority to saline injection at 12-month follow-up. MRI cartilage sequences failed to show regenerative benefit with single BMAC injection. The mechanisms of action that led to pain relief remain unclear and warrant further studies.

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.…”

Minimally Manipulated Mesenchymal Stem Cells for the Treatment of Knee Osteoarthritis: A Systematic Review of Clinical Evidence

“…Of these last three papers, one study involved the administration of 4 sequential injections within a 3-month timespan [17]. Other authors administered combined BMAC and PRP within the same session [19, 21, 22] or administered PRP alone after a certain period as a booster injection [20]. Finally, two authors injected BMAC in association with adipose tissue [22, 23].…”

Management of osteoarthritis - biological approaches: current concepts

“…The same group of authors followed these patients out to 12 months, at which point they obtained MRI T2 quantitative mapping to evaluate cartilage appearance. No significant differences were identified on T2 quantitative MRI mapping between the saline control and BMAC knees 54. Others have reported case series on BMAC for OA, specifically a series of 681 patients (840 knees) by Centeno et al 55.…”