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

Adam W Anz, Ryan Hubbard, Nicole K Rendos, Peter A Everts, James R Andrews, Joshua G Hackel, Adam W Anz, Ryan Hubbard, Nicole K Rendos, Peter A Everts, James R Andrews, Joshua G Hackel

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).

Keywords: bone marrow aspirate; bone marrow concentrate; osteoarthritis; platelet-rich plasma; regenerative medicine.

Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: The Andrews Research & Education Foundation received funding and material support from EmCyte to support this study. A.W.A. has received educational and research support from Arthrex and CGG Medical; consulting fees from Arthrex, Bioventus, Ceterix, MicroAire, and Blue Belt Technologies; speaking fees from Arthrex and Smith & Nephew; royalties from Arthrex; and hospitality payments from Procedural Orthopedics. P.A.E. is employed by EmCyte. J.R.A. has received speaking fees from Arthrex and Halyard Health; has received consulting fees from Theralase Technologies, Bauerfeind, and Physiotherapy Associates/Select Medical; and has stock/stock options in FastHealth, Patient Connection, Connective Orthopaedics, and Contessa Health. J.G.H. has received consulting fees from Carticept Medical, Fujifilm SonoSite, and Ferring Pharmaceuticals; speaking fess from Ferring Pharmaceuticals; honoraria from Tenex Health, Avanos Medical, and Fidia Pharma; and educational support from Tenex Health. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

© The Author(s) 2020.

Figures

Figure 1.
Figure 1.
CONSORT (Consolidated Standards of Reporting Trials) flow diagram. BMC, bone marrow aspirate concentrate; PRP, platelet-rich plasma.
Figure 2.
Figure 2.
Overall (A) International Knee Documentation Committee (IKDC) scores and (B) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores versus time for the bone marrow aspirate concentrate (BMC) and platelet-rich plasma (PRP) treatment groups. *Significant difference from baseline for BMC (P < .05). ^Significant difference from baseline for PRP (P < .05).

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