Shane A Shapiro1, Jennifer R Arthurs2, Michael G Heckman3, Joseph M Bestic4, Shari E Kazmerchak1, Nancy N Diehl3, Abba C Zubair5, Mary I O'Connor6. 1. Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL, USA. 2. Division of Transplant Medicine, Mayo Clinic, Jacksonville, FL, USA. 3. Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, USA. 4. Department of Radiology, Mayo Clinic, Jacksonville, FL, USA. 5. Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL, USA. 6. Department of Orthopedic Surgery, Yale-New Haven Hospital, New Haven, CT, USA.
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 betweenBMAC-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.
RCT Entities:
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.
Authors: Raveendhara R Bannuru; Christopher H Schmid; David M Kent; Elizaveta E Vaysbrot; John B Wong; Timothy E McAlindon Journal: Ann Intern Med Date: 2015-01-06 Impact factor: 25.391
Authors: Richard Kijowski; Donna G Blankenbaker; Alejandro Munoz Del Rio; Geoffrey S Baer; Ben K Graf Journal: Radiology Date: 2013-01-07 Impact factor: 11.105
Authors: Shane A Shapiro; Jennifer R Arthurs; Michael G Heckman; Joseph M Bestic; Nancy N Diehl; Abba C Zubair; Mary I O'Connor Journal: Cartilage Date: 2019-07-11 Impact factor: 4.634