Published: 2019-01-25

Functional outcomes of bone marrow aspirate concentrate application in osteoarthritis of the knee

Safa Gursoy, Mustafa Akkaya, Mehmet Emin Simsek, Murat Bozkurt


Background: Osteoarthritis (OA) of the knee is a very common musculoskeletal disorder. Although total knee replacement is a suitable option in the treatment of severe OA, it has some limitations when performed in the early stage and early age. Bone marrow aspirate concentrate (BMAC), which is rich in mesenchymal stem cells, is promising due to its potentially regenerative and symptomatic effects in many disorders of the musculoskeletal system. This study aims to investigate the efficacy of BMAC in terms of functional recovery in OA of the knee joint.

Methods: Total of 52 patients with unilateral symptomatic knee OA but no inflammatory disease, advanced malalignment or instability were enrolled in this study. Bone marrow aspirate was collected from the iliac crest in one session, prepared using a manufactured kit and the patients received intra-articular injections of this BMAC. The mean age of the patients was 59.2±7.4 and the mean follow-up period was 22.1±3.6 months. Functional outcomes of the patients were evaluated using Modified Cincinnati and Tegner Lysholm scoring systems.

Results: It was observed that both Lysholm and Cincinnati scores of the patients were statistically significantly higher throughout the follow-up period as compared to the period before the procedure (p=0.0001). There was no statistically significant difference in Lysholm and Cincinnati ratings between gender, side and body mass index groups throughout the follow-up period (p >0.05). It was found that the results of the patients with Kellgren-Lawrence Grade 4 severe joint arthrosis were statistically significantly lower (p <0.05).

Conclusions: Considering the functional outcomes of the patients up to two years, it was observed that the application of concentrated bone marrow aspirate provided functional recovery in arthrosis of the knee joint.


Bone marrow aspirate concentrate, Degenerative joint disease, Knee osteoarthritis, Stem cells

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Murphey, L. Helmick, C. The impact of osteoarthritis in the United States: a population-health perspective. Am J Nursing. 2012;112(3):S13-9.

Goldring M. Goldring S. Articular cartilage and subchondral bone in the pathogenesis of osteoarthritis. Ann NY Acad Sci. 2010;1192:230-7.

Heidari, B. Knee osteoarthritis prevalence, risk factors, pathogenesis and features: Part 1. Caspian J Intern Med. 2011;2(2):205-12.

Dorotka R, Bindreiter U, Macfelda K, Windberger U, Nehrer S. Marrow stimulation and chondrocyte transplantation using a collagen matrix for cartilage repair. Osteoarthr Cartil/OARS, Osteoarthr Res Soc. 2005;13(8):655-64.

Dorotka R, Windberger U, Macfelda K, Bindreiter U, Toma C, Nehrer S. Repair of articular cartilage defects treated by microfracture and a three-dimensional collagen matrix. Biomaterials. 2005;26(17):3617-29.

Heck DA, Robinson RL, Partridge CM, Lubitz RM, Freund DA. Patient outcomes after knee replacement. Clin Orthop Relat Res. 1998;(356):93-110.

Kaiser LR. The future of multihospital systems. Topics Health Care Financing. 1992;18(4):32-45.

Kozhevnikova MN, Mikaelyan AS, Payushina OV, Starostin VI. Comparative characterization of mesenchymal bone marrow stromal cells at early and late stages of culturing. Biol Bull. 2008 Apr 1;35(2):132-8.

Centeno CJ, Busse D, Kisiday J, Keohan C, Freeman M, Karli D. Regeneration of meniscus cartilage in a knee treated with percutaneously implanted autologous mesenchymal stem cells. Med Hypotheses. 2008;71(6):900-8.

Centeno C, Pitts J, Al-Sayegh H, Freeman M. Efficacy of autologous bone marrow concentrate for knee osteoarthritis with and without adipose graft. BioMed Res Int. 2014;2014.

Davatchi F, Abdollahi B, Mohyeddin M, Shahram F, Nikbin B. Mesenchymal stem cell therapy for knee osteoarthritis: preliminary report of four patients. Int J Rheum Dis. 2011;14(2):211-5.

Gobbi A, Whyte G. One-stage cartilage repair using a hyaluronic acid based scaffold with activated bone marrow-derived mesenchymal stem cells compared with microfracture: Five-year follow-up. Am J Sports Med. 2016; 44(11):2846-54.

Kim J, Lee G, Jung G, Kim C, Kim T, Park J, et al. Outcome of autologous bone marrow aspirate concentrate injection in degenerative arthritis of the knee. Eur J Orthop Surg Traumatol. 2014;24(1):1505-11.

Koh Y, Jo S, Kwon O. Mesenchymal stem cell injections improve symptoms of knee osteoarthritis. Arthroscopy. 2013;29(4):748-55.

Orozco, L, Munar, A, Soler, R. Treatment of knee osteoarthritis with autologous mesenchymal stem cells: two-year follow-up results. Transplantation. 2014;97(11):e66-8.

Shapiro, S. Kazmerchak, S. Heckman, M. Zubair, A. O’Conner, M. A prospective, single-blind, placebo-controlled trial of bone marrow aspirate concentrate for knee osteoarthritis. Am J Sports Med. 2016;45(1):82-90.

Steadman JR, Briggs KK, Rodrigo JJ, Kocher MS, Gill TJ, Rodkey WG. Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up. Arthroscopy. 2003;19(5):477-84.

Kreuz PC, Erggelet C, Steinwachs MR, Krause SJ, Lahm A, Niemeyer P, et al. Is microfracture of chondral defects in the knee associated with different results in patients aged 40 years or younger?. Arthroscopy. 2006 Nov 1;22(11):1180-6.

Mithoefer K, Williams RJ 3rd, Warren RF, Potter HG, Spock CR, Jones EC, Wickiewicz TL, Marx RG. The microfracture technique for the treatment of articular cartilage lesions in the knee. A prospective cohort study. J Bone Joint Surg Am. 2005 Sep;87(9):1911-20.