Short-Term Outcomes in Treatment of Knee Osteoarthritis With 4 Bone Marrow Concentrate Injections

Abstract

Background:Preliminary research suggests that bone marrow concentrate (BMC), which contains mesenchymal stem cells and platelets, is a promising treatment for knee osteoarthritis. The aim of this study was to build on this preliminary research by reporting the short-term progress of 15 patients (20 knees) with knee osteoarthritis through 4 BMC treatments.Methods:Patients underwent four sequential BMC treatments with mean injection times of 13.80 days after the first treatment, 21.40 days after the second treatment, and 33.50 days after the third treatment. The last follow-up was conducted a mean 86 days after the first treatment. Baseline and posttreatment outcomes of resting pain, active pain, lower functionality scale, and overall improvement percentage were compared after each treatment.Results:Patients experienced statistically significant improvements in active pain and functionality score after the first treatment. Additionally, patients experienced a mean decrease in resting pain after the first treatment, yet outcomes were not statistically significant until after the second treatment. On average, patients experienced an 84.31% decrease in resting pain, a 61.95% decrease in active pain, and a 55.68% increase in functionality score at the final follow-up. Patients also reported a mean 67% total overall improvement at study conclusion. Outcomes at the final follow-up after the fourth treatment were statistically significant compared to outcomes at baseline, after first treatment, after second treatment, and after third treatment.Conclusions:These results are promising, and additional research with a larger sample size and longer follow-up is needed to further examine the treatment effectiveness of multiple BMC injections for knee osteoarthritis.

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

“…Regarding the therapeutic protocol, five papers dealt with the administration of BMAC alone: two of these involved subchondral BMAC injections [24, 25], whilst in the remaining three, BMAC was injected intra-articularly [16–18]. 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].…”

“…In regard to the clinical outcome, the majority of authors employed reliable clinical scores (such as those derived from WOMAC, IKDC, KOOS, or KSS), whereas only a few authors used less known questionnaires, improvement rating scores, or patient satisfaction [17, 20–22]. All studies assessed pain through a visual or numerical score such as VAS or NPS, except for two authors [18, 25] who included WOMAC and KSS questionnaires, which have sections on patient pain.…”

Clinical Update: Why PRP Should Be Your First Choice for Injection Therapy in Treating Osteoarthritis of the Knee

“…While there is some evidence in the literature of a positive effect of MSCs on KOA [110][111][112][113], there is a lack of level I evidence indicating stem cell therapy for KOA. Furthermore, a recent prospective, placebo-controlled FDA monitored study found that at 6 months follow-up, BMAC injections provided the same amount of improvement in pain and activity as saline [114•].…”