Bone marrow concentrate (BMC) has been used for the treatment of osteoarthritis for several years now. Whilst scientific literature demonstrates the benefits of the treatment, unfortunately the publications available have some shortcomings. This includes the use of a small number of patients and the lack of a randomised control group. At the Orthobiologics Clinic we are excited by the potential benefits BMC offers for patients with pain caused by osteoarthritis. BMC contains a potent mix of stem cells, growth factors, bone proteins and anti-inflammatory substances. We feel that this is a valuable treatment with promising outcomes. However, we would appreciate some prospective randomised trials comparing BMC with other treatments such as steroid injections.
The investigators treated 45 patients (75 knees) with osteoarthritis of the knee with a single bone marrow and adipose fat concentrate injection. Patients were then followed up at 3,6 and 12 months. The authors concluded that BMC injections significantly improved both knee pain and function in patients with degenerative arthritis of the knee. In addition to this, the injection has been shown to be more effective in the early to moderate stages of arthritis, and even patients with severe arthritis showed improvements following BMC treatment.
At the Orthobiologics Clinic we feel it is unusual to combine bone marrow derived stem cells with those derived from abdominal fat. However unusual the combination, the treatment appears to work well for patients with mild and moderate osteoarthritis. Patients with severe osteoarthritis still saw improvements, but not to the same extent.
The authors analysed the data of 70 patients who underwent treatment with bone marrow concentrate (BMC) for osteoarthritis of the knee. The average scores for pain, activity, quality of life and sporting activities improved significantly. The authors concluded that this study of intra-articular injection of autologous bone marrow concentrate and lipoaspirate in patients diagnosed with knee osteoarthritis demonstrates encouraging results for positive outcomes without complications. Further study with randomized controlled trials is warranted to prove the potential of this intervention.
The authors treated 102 patients (115 shoulders) who were diagnosed with osteoarthritis of the shoulder and/or rotator cuff tears with bone marrow concentrate (BMC) and PRP (platelet rich plasma). Patients reported a continued improvement in outcome scores for up to 2 years. The self-rated improvement was 48.8%. The results were the same for patients with arthritis and/or rotator cuff tears. The authors concluded: The use of BMC to treat symptomatic rotator cuff tears and glenohumeral OA is promising, and in an uncontrolled treatment registry population, effective at both reducing pain and improving function. Randomized clinical trials are required to confirm the efficacy of BMC injections for treatment of shoulder OA and rotator cuff tears.
At the Orthobiologics Clinic we have noticed some flaws in the methodology of the publication such as the mixing of patients with arthritis and rotator cuff tears and the failure to report the average follow-up times. Within those limitations however, it looks as if the treatment protocol led to an obvious improvement in pain and function.
The investigators followed up 17 patients (19 hips) for 3 to 6 months. All patients received an injection with bone marrow concentrate for symptomatic osteoarthritis of the hip. Outcome scores for pain and function improved significantly. The authors concluded: These results suggest that BMC therapy for the treatment of hip OA can improve hip function and reduce pain over 6 months.
At the Orthobiologics Clinic we were a bit disappointed with the short follow up and the small number of patients in this study. Nevertheless, this is one of the few publications looking into the treatment of hip arthritis with bone marrow concentrate (BMC) and the reported outcomes are promising.
To our knowledge this is the first publication directly comparing the outcomes between treatment with mesenchymal stem cells obtained from either bone marrow or adipose fat. The authors used the Lipogems system to obtain the adipose fat graft. 76 patients (106 knees) with osteoarthritis of the knee were included. Patients in the bone marrow group were followed up for 1.8 years while patients in the adipose fat (Lipogems) group were followed up for 1.08 years. At the time of the final follow-up there was a significant improvement in pain and function scores in both groups. There was no significant difference in outcomes between the groups. The authors concluded that this is a novel study that compares outcomes between bone marrow and adipose tissue derived orthobiologic injections for symptomatic knee arthritis. Based on our data, the autologous tissue source does not affect outcomes as both BMC and MFAT (Lipogems) groups had significantly improved pain and function compared with their baseline without a significant difference in improvements between the two treatment groups.
At the Orthobiologics clinic we were delighted to see that both treatments work equally well, although we would welcome a randomised controlled trial investigating this issue further.