Combined subchondral and intra-articular injections of bone marrow aspirate concentrate provide stable results up to 24 months

Purpose The aim of this study was to evaluate the clinical and imaging findings up to 24 months of follow-up in patients treated with combined subchondral and intra-articular bone marrow aspirate concentrate (BMAC) injections for the treatment of knee osteoarthritis (OA). Methods Thirty consecutive patients (19 males, 11 females) aged between 40 and 75 years (mean age 56.4 +/- 8.1 years) with unilateral symptomatic knee OA (Kellgren-Lawrence 2-3) were included in the study. Patients were treated with combined intra-articular and subchondral bone BMAC injections (total 9 ml) under fluoroscopic control. IKDC subjective score, VAS for pain, KOOS, and EQ-VAS were prospectively evaluated up to 24 months. Radiographs were performed at baseline and at 24 months after the procedure. MRI was evaluated with the WORMS score at baseline, 6-12 months, and 24 months of follow-up. The statistical analysis was performed using SPSS v.19.0 and for all tests p < 0.05 was considered significant. Results No major complications and a 13% failure rate were reported. The IKDC subjective score remained stable from 62.6 +/- 19.4 at 12 months to 63.4 +/- 17.1 at 24 months (both p < 0.0005 compared to baseline, 40.5 +/- 12.5). Similar improvements were reported for all KOOS subscales, while EQ-VAS did not report any significant improvement. VAS pain worsened from 3.0 +/- 1.9 at 12 months to 4.4 +/- 1.8 at the final follow-up (p = 0.0001), although remaining lower compared to the baseline value of 6.3 +/- 1.8 (p = 0.002). The radiographic evaluation did not reveal signs of improvement or deterioration of the OA grade. The MRI findings showed a worsening in marginal osteophytes and synovitis, but a significant reduction of bone marrow edema at 24 months (p < 0.0005). Conclusion Combined intra-articular and subchondral BMAC injections provided clinical and imaging benefits up to 24 months for the treatment of symptomatic knee OA, with durable clinical results, a low failure rate, and a significant reduction of bone marrow edema.