Subchondral and intra-articular injections of bone marrow concentrate are a safe and effective treatment for knee osteoarthritis: a prospective, multi-center pilot study.

Autor: Kon E; IRCCS Humanitas Research Hospital, Rozzano, MI, Italy.; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy., Boffa A; Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy. angeloboffa@libero.it., Andriolo L; Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy., Di Martino A; Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy., Di Matteo B; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy.; First Moscow State Medical University, Sechenov University, Moscow, Russia., Magarelli N; IRCCS Humanitas Research Hospital, Rozzano, MI, Italy., Marcacci M; IRCCS Humanitas Research Hospital, Rozzano, MI, Italy.; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy., Onorato F; IRCCS Humanitas Research Hospital, Rozzano, MI, Italy., Trenti N; IRCCS Humanitas Research Hospital, Rozzano, MI, Italy., Zaffagnini S; Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy., Filardo G; Applied and Translational Research (ATR) Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
Jazyk: angličtina
Zdroj: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA [Knee Surg Sports Traumatol Arthrosc] 2021 Dec; Vol. 29 (12), pp. 4232-4240. Date of Electronic Publication: 2021 Mar 27.
DOI: 10.1007/s00167-021-06530-x
Abstrakt: Purpose: Subchondral bone is becoming a treatment target for knee OA patients, with promising early findings on the use of bone marrow aspirate concentrate (BMAC). The aim of this prospective, multi-centric pilot study was to evaluate safety as well as clinical and MRI outcomes of a combined approach of intra-articular and subchondral BMAC injections.
Methods: Thirty patients (19 men, 11 women, 56.4 ± 8.1 years) with symptomatic knee OA were treated with a combination of an intra-articular and two subchondral BMAC injections (femoral condyle and tibial plateau). Patients were evaluated at baseline and at 1-3-6-12 months of follow-up with the IKDC subjective, VAS, KOOS, and EQ-VAS scores. The MRI evaluation was performed with the WORMS score.
Results: No major complications were reported and only two patients were considered treatment failures, requiring a new injective or surgical treatment. The IKDC subjective score improved significantly from 40.5 ± 12.5 to 59.9 ± 16.1 at 3 months, 59.1 ± 12.2 at 6 months, and 62.6 ± 19.4 at 12 months (p < 0.0005). A similar improvement was reported for VAS pain and all KOOS subscales at all follow-ups, while EQ-VAS did not show any significant improvement. The MRI analysis showed a significant bone marrow edema reduction (p = 0.003), while the remaining WORMS parameters did not show any significant changes.
Conclusion: The pilot evaluation of this combined BMAC injective treatment showed safety and positive outcome up to 12 months of follow-up in patients with symptomatic knee OA associated with subchondral bone alterations. These findings suggest that targeting both subchondral bone and joint environment can provide promising results, and that BMAC can be a valid option for this combined approach to treat knee OA.
(© 2021. European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).)
Databáze: MEDLINE
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