Bone marrow aspirate concentrate may not benefit patients undergoing meniscectomy
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Key takeaways:
- Bone marrow aspirate concentrate injections may not provide benefit as an adjuvant for arthroscopic partial meniscectomy.
- Bone marrow aspirate concentrate was associated with similar outcomes vs. controls.
Published results showed autologous bone marrow aspirate concentrate injections may not provide benefit as an adjuvant for patients with meniscal tears and concomitant knee osteoarthritis who undergo arthroscopic partial meniscectomy.
Adam B. Yanke, MD, PhD, director of clinical research for the department of orthopedics and co-director of the cartilage restoration center at Rush University Medical Center, and colleagues performed a prospective, randomized controlled trial of 83 patients who underwent arthroscopic partial meniscectomy for symptomatic meniscal tears and mild knee OA.
Yanke and colleagues randomly assigned 44 patients (mean age, 55.2 years) to receive a 60 mL injection of autologous bone marrow aspirate concentrate (BMAC) into the operative knee during surgery and 39 patients (mean age, 54.9 years) to undergo surgery without BMAC.
Patient-reported outcomes were collected at 3 months, 6 months, 1 year and 2 years after surgery and included IKDC, KOOS, VAS and Veterans RAND 12-item (VR-12) scores. Yanke and colleagues also assessed Kellgren-Lawrence grades on radiographs.
Overall, Yanke and colleagues found no statistically significant differences between mean IKDC score at 1 year for patients who received BMAC (68.1) vs. patients who did not receive BMAC (70.4). They found no statistically significant differences in Kellgren-Lawrence grades, KOOS, VAS or VR-12 scores between the groups at any postoperative time point. They noted both groups had significant improvements in all patient-reported outcomes. However, Kellgren-Lawrence grades indicated significant radiographic progression of OA.
Yanke and colleagues noted patients who received BMAC were more likely to achieve the minimal clinically important difference (MCID) for KOOS sport and symptoms subscales at 1 year. However, they found no other statistically significant differences in MCID achievement for any other outcomes between the groups.
Yanke and colleagues concluded arthroscopic partial meniscectomy may benefit patients with meniscal tears and knee OA with or without BMAC.
Perspective
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We commend the authors for presenting this randomized, controlled trial that investigates the effect of autologous bone marrow aspirate concentrate (BMAC) on patients who underwent arthroscopic partial meniscectomy. Previous studies, such as an RCT by C. Thomas Vangsness Jr., MD, and colleagues, found there was a significant difference in short-term outcomes when cultured mesenchymal stem cells were utilized. However, this study confirms our previous data that showed no difference in the short-term outcomes between patients that had partial meniscectomy with and without BMAC.
We still remain interested in seeing the 2- and 5-year outcomes of these subgroups to identify a difference in arthritic progression and conversion to knee arthroplasty between the two groups. In addition, we published improved short-term outcomes when treating patients with BMAC/cartilage-derived matrix implantation compared with chondroplasty alone in patients with Outerbridge grade 3 to 4 chondral defects of the knee.
These studies demonstrated the need for long-term outcomes on the progression of arthritis in patients treated with BMAC. These also highlight the need for an adjuvant with the use of BMAC to affect short-term outcomes.
References:
Dávila Castrodad IM, et al. Arthrosc Sports Med Rehabil. 2021;doi:10.1016/j.asmr.2021.10.018.
Dávila Castrodad IM, et al. Degenerative meniscal tears: A comparison of postoperative outcomes following meniscectomy with and without bone marrow aspirate concentrate. Presented at: International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine Global Congress; Nov. 27-28, 2021; Rosemont, Illinois.
Vangsness CT Jr, et al. J Bone Joint Surg Am. 2014;doi:10.2106/JBJS.M.00058.
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