A specific protocol of autologous bone marrow concentrate and platelet products versus exercise therapy for symptomatic knee osteoarthritis: a randomized controlled trial with 2 year follow-up

Christopher Centeno, Mitchell Sheinkop, Ehren Dodson, Ian Stemper, Christopher Williams, Matthew Hyzy, Thomas Ichim, Michael Freeman, Christopher Centeno, Mitchell Sheinkop, Ehren Dodson, Ian Stemper, Christopher Williams, Matthew Hyzy, Thomas Ichim, Michael Freeman

Abstract

Background: Cell-based therapies have shown promise for the treatment of knee osteoarthritis (OA). The current study compared exercise therapy to autologous bone marrow concentrate (BMC) and platelet products for knee OA treatment.

Methods: Patients with symptomatic knee OA (N = 48) were randomized into either an exercise therapy control group or treatment group with injection of autologous BMC and platelet products. Patients in the control group could crossover to BMC treatment after 3 months. Clinical outcomes were documented at baseline and at 6-weeks, 3, 6, 12 and 24 months, including the Knee Society Score (KSS), Pain Visual Analogue Scale, Short Form-12 Scales (SF-12), and Lower Extremity Activity Scale (LEAS).

Results: All patients in the exercise group crossed over to receive BMC treatment after 3 months (N = 22 crossover). At 3 months, KSS-knee, SF-12 Physical, and LEAS improved significantly in the crossover group compared to exercise, similar to significant improvements on KSS-knee and LEAS for the treatment group (N = 26) compared to exercise group at 3 months. After BMC treatment, patients' clinical outcome scores (except SF-12 Mental Health), were significantly improved through the 2-year follow-up compared to baseline. No serious adverse events were reported.

Conclusion: The use of image-guided percutaneous BMC with platelet products yielded better results than exercise therapy as an effective alternative therapy for patients with symptomatic moderate to moderate-severe osteoarthritis of the knee. Trial registration NCT02034032. https://ichgcp.net/clinical-trials-registry/NCT02034032 . Registered 13 January 2014.

Keywords: Articular cartilage; Bone marrow concentrate; Exercise therapy; Knee osteoarthritis; Regenerative therapy.

Figures

Fig. 1
Fig. 1
Study flow diagram
Fig. 2
Fig. 2
Average scores at baseline and 3-months for exercise, crossover, and treatment groups. *p a KSS-knee, b LEAS, c SF-12
Fig. 3
Fig. 3
Average clinical outcome scores with standard deviation bars. Significant differences from baseline **p a VAS; b KSS-knee score; c KSS-function score; and d SF-12 Physical

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