Table 2.
Summary of Recent Clinical Investigations Performed Evaluating Bone Marrow Aspirate Concentrate in the Realm of Cartilage Repair/Restoration.
| Study | Population | Groups | End Point | Findings |
|---|---|---|---|---|
| Gobbi et al. (2011)70 | • 15 patients • ICRS grade IV lesions • Mean age 48 years |
BMAC embedded with a collagen I/III matrix | 24-month follow-up | • Significant improvement in KOOS, IKDC, Lysholm, Marx, SF-36 and Tegner scores at 6, 12, and 24 months • MRI at 1 and 2-years complete defect fill in 80% of defects • 3 specimens were histologically analyzed and demonstrated hyaline-like tissue |
| Gobbi et al. (2014)71 | • 25 patients • ICRS grade IV lesions • mean age 46.5 years |
BMAC embedded with a collagen I/III matrix | Minimum 3-year follow-up; mean 41.3 months | • Average number of colony forming units 4041 (range 2500-5700) • Significant improvement in KOOS, IKDC, Lysholm, Marx, and Tegner scores at final follow-up • All patients returned to previous daily and specific sporting activities (32% at preinjury level, however) • Complete defect filling on MRI at final follow-up in 80% • Patients younger than 45 years and with smaller or single defects had better outcomes |
| Enea et al. (2015)67 | • 9 patients • Outerbridge grade III or IV lesions |
Treated with arthroscopic MFX covered with a collagen membrane immersed in BMAC | Mean 29-month follow-up | • Significant improvement in IKDC, Lysholm, and mean VAS at final follow-up • One failure—underwent successive surgery • On second-look arthroscopy, all but 1 patients were asymptomatic and 4 were classified as nearly normal ICRS grade • Mostly hyaline-like cartilage was only seen histologically in 1 of the 4 patients with ICRS grade II repair tissue |
| Gobbi et al. (2017)74 | • 40 total patients • Prospectively evaluated for 4 years • ICRS grade IV lesions |
• Group 1: 20 patients older than 45 years (mean 50) • Group 2: 20 patients younger than 45 years (mean 36.6) • BMAC embedded in a hyaluronan-based scaffold—younger group |
4-years | • At final follow-up, significant improvement in all KOOS score categories, Tegner, IKDC in both age groups • Lesions <8 cm2 had significantly better IKDC scores as did patients with single lesions • MRI at final follow-up demonstrated completed defect filling in 80% of those >45 years and 71% in those <45 years. • 3 patients from older group and 2 from younger group had repair tissue histologically analyzed—demonstrated mix of hyaline-fibrocartilage mainly |
| Gobbi and Whyte (2016)77 | • 50 patients • ICRS grade IV lesions • Prospective cohort study minimum 5-year follow-up |
• Group 1: 25 patients—treated with hyaluronic acid–based scaffold with BMAC • Group 2: 25 patients treated with BMAC |
5-years | • Tegner, KOOS-pain, and KOOS-sport scores at 5 years were significantly greater in the HA-BMAC group • Significantly greater proportion of patients treated with HA-BMAC were classified as normal or near normal at 2- and 5-year follow-up on IKDC score • Age >45 years, larger lesion size, and treatment of multiple lesions were not associated with inferior outcomes in HA-BMAC group but were seen in the microfracture group |
| Krych et al. (2016)76 | • 46 patients • Outerbridge grades III or IV lesions • Only patients treated with TruFit scaffold (Smith & Nephew, Andover, MD, USA) |
• Group 1: scaffold only (n = 1) • Group 2: scaffold with PRP (n = 23) • Group 3: scaffold with BMAC (n = 12) |
12-months | • PRP (78%) and BMAC (75%) groups had superior cartilage fill (67%-100% fill) compared to control group (18%) • On MRI at 12 months, PRP group had a similar mean T2 value to that of control group while BMAC had a mean T2 value closer to that of superficial hyaline cartilage |
MFX = microfracture; HA = hyaluronic acid; BMAC = bone marrow aspirate concentrate; PRP = platelet-rich plasma; ICRS = International Cartilage Repair Society; KOOS = Knee Injury and Osteoarthritis Outcome Score; IKDC = International Knee Documentation Committee; VAS = visual analog scale; MRI = magnetic resonance imaging.