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Combined subchondral and intra-articular injections of bone marrow aspirate concentrate provide stable results up to 24 months

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The aim of this study was to evaluate the clinical and imaging findings up to 24 months of follow-up in patients treated with combined subchondral and intra-articular bone marrow aspirate concentrate (BMAC) injections for the treatment of knee osteoarthritis (OA).

Methods

Thirty consecutive patients (19 males, 11 females) aged between 40 and 75 years (mean age 56.4 ± 8.1 years) with unilateral symptomatic knee OA (Kellgren–Lawrence 2–3) were included in the study. Patients were treated with combined intra-articular and subchondral bone BMAC injections (total 9 ml) under fluoroscopic control. IKDC subjective score, VAS for pain, KOOS, and EQ-VAS were prospectively evaluated up to 24 months. Radiographs were performed at baseline and at 24 months after the procedure. MRI was evaluated with the WORMS score at baseline, 6–12 months, and 24 months of follow-up. The statistical analysis was performed using SPSS v.19.0 and for all tests p < 0.05 was considered significant.

Results

No major complications and a 13% failure rate were reported. The IKDC subjective score remained stable from 62.6 ± 19.4 at 12 months to 63.4 ± 17.1 at 24 months (both p < 0.0005 compared to baseline, 40.5 ± 12.5). Similar improvements were reported for all KOOS subscales, while EQ-VAS did not report any significant improvement. VAS pain worsened from 3.0 ± 1.9 at 12 months to 4.4 ± 1.8 at the final follow-up (p = 0.0001), although remaining lower compared to the baseline value of 6.3 ± 1.8 (p = 0.002). The radiographic evaluation did not reveal signs of improvement or deterioration of the OA grade. The MRI findings showed a worsening in marginal osteophytes and synovitis, but a significant reduction of bone marrow edema at 24 months (p < 0.0005).

Conclusion

Combined intra-articular and subchondral BMAC injections provided clinical and imaging benefits up to 24 months for the treatment of symptomatic knee OA, with durable clinical results, a low failure rate, and a significant reduction of bone marrow edema.

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Acknowledgements

The authors would like to acknowledge Elettra Pignotti for her help with the statistical analysis, Maurizio Busacca for assistance in MRI evaluation, and Zimmer Biomet for providing kits and centrifuge.

Funding

This research received no external funding.

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Authors and Affiliations

  1. IRCCS Humanitas Research Center, Rozzano, Milan, Italy

    Elizaveta Kon, Berardo Di Matteo, Nicola Magarelli & Nicoletta Trenti

  2. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy

    Elizaveta Kon & Berardo Di Matteo

  3. Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy

    Angelo Boffa, Luca Andriolo, Alessandro Di Martino & Stefano Zaffagnini

  4. Applied and Translational Research (ATR) Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy

    Giuseppe Filardo

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  1. Elizaveta Kon
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Contributions

Conceptualization EK and GF; Methodology, ADM, BDM, NM, and NT; data curation AB; writing—original draft preparation, AB and LA; writing—review and editing EK and GF; supervision SZ. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Angelo Boffa.

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Conflict of interest

EK reports consulting for Cartiheal ldt, Green Bone, Geistlich, and Bioveex, and speaking for Zimmer Biomet and Fidia Farmaceutici SPA. SZ reports non-financial support from personal fees from I + SRL, grants from Fidia Farmaceutici SPA, Cartiheal ltd, IGEA clinical biophysics, BIOMET, and Kensey Nash, outside the submitted work.The funders had no role in the design of the study, in the collection, analyses, or interpretation of data, in the writing of the manuscript, or in the decision to publish the results. The other authors declare no conflict of interest.

Ethical approval

Approval was obtained by the Hospital Ethics Committee of IRCCS Istituto Ortopedico Rizzoli (prot. gen. n. 0013097).

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Participation was voluntary and informed consent was obtained from each patient.

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Kon, E., Boffa, A., Andriolo, L. et al. Combined subchondral and intra-articular injections of bone marrow aspirate concentrate provide stable results up to 24 months. Knee Surg Sports Traumatol Arthrosc 31, 2511–2517 (2023). https://doi.org/10.1007/s00167-022-07195-w

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