Bone Marrow Aspirate Concentrate versus Platelet Rich Plasma or Hyaluronic Acid for the Treatment of Knee Osteoarthritis

Medicina

Gordan Gavrilovic¹  Ivica Lalic²  Vaso Kecojevic²  Predrag Rasovic²  Marko Bumbasirevic³  Oliver Dulic³  Dusan Maric⁴  Dzihan Abazovic⁵  Mladen Miskulin⁶ 

[1] Atlas Hospital, 11000 Belgrade, Serbia;Department for Orthopedic Surgery and Traumatology, Clinical Center of Vojvodina, Hajduk Veljkova 1-9, 21000 Novi Sad, Serbia;Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia;Medical Faculty, University of Novi Sad, 21000 Novi Sad, Serbia;Renova Hospital Belgrade, 11000 Belgrade, Serbia;Specijalna Bolnica za Neurokirurgiju i Ortopediju Aksis, 10000 Zagreb, Croatia;

关键词: bone marrow aspirate concentrate;    platelet rich plasma;    hyaluronic acid;    knee osteoarthritis;    regenerative medicine;    stem cells;   

DOI  :  10.3390/medicina57111193

来源: DOAJ

【 摘 要 】

Background: In the last decade, regenerative therapies have become one of the leading disease modifying options for treatment of knee osteoarthritis (OA). Still, there is a lack of trials with a direct comparison of different biological treatments. Our aim was to directly compare clinical outcomes of knee injections of Bone Marrow Aspirate Concentrate (BMAC), Platelet-rich Plasma (PRP), or Hyaluronic acid (HA) in the OA treatment. Methods: Patients with knee pain and osteoarthritis KL grade II to IV were randomized to receive a BMAC, PRP, and HA injection in the knee. VAS, WOMAC, KOOS, and IKDC scores were used to establish baseline values at 1, 3, 6, 9, and 12 months. All side effects were reported. Results: A total of 175 patients with a knee osteoarthritis KL grade II-IV were randomized; 111 were treated with BMAC injection, 30 with HA injection, and 34 patients with PRP injection. There were no differences between these groups when considering KL grade, BMI, age, or gender. There were no serious side effects. The mean VAS scores after 3, 7, 14, and 21 days showed significant differences between groups with a drop of VAS in all groups but with a difference in the BMAC group in comparison to other groups (p < 0.001). There were high statistically significant differences between baseline scores and those after 12 months (p < 0.001) in WOMAC, KOOS, KOOS pain, and IKDC scores, and in addition, there were differences between these scores in the BMAC group in comparison with other groups, except for the PRP group in WOMAC and the partial IKDC score. There were no differences between the HA and PRP groups, although PRP showed a higher level of clinical improvement. Conclusions: Bone marrow aspirate concentrate, Leukocyte rich Platelet Rich Plasma, and Hyaluronic acid injections are safe therapeutic options for knee OA and provide positive clinical outcomes after 12 months in comparison with findings preceding the intervention. BMAC could be better in terms of clinical improvements in the treatment of knee OA than PRP and HA up to 12 months. PRP provides better outcomes than HA during the observation period, but these results are not statistically significant. More randomized controlled trials and high quality comparative studies are needed for direct correlative conclusions.

【 授权许可】

Unknown