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

Dulic O, Rasovic P, Lalic I, et al. · Medicina (Kaunas)

At 12 months BMAC separated from HA on every score - KOOS pain by 15.301 (p=0.002), WOMAC by 10.949 (p=0.035), IKDC by 15.224 (p=0.002) - and from PRP on none of them (KOOS pain p=0.170, WOMAC p=0.306, IKDC p=0.086). HA and PRP did not differ at any timepoint on any measure. All three arms improved against their own baselines and none improved further after the first month. The early VAS separation the abstract leads with is measured in days rather than months: BMAC against both others at 3, 7, 14 and 21 days, p<0.001. Two of the scores on which BMAC later beat HA already favoured the BMAC arm before treatment - KOOS pain (p=0.036) and IKDC (p=0.020).

Population

175 knee OA patients of Kellgren-Lawrence grade II-IV (111 BMAC, 34 PRP, 30 HA)

Intervention

Single BMAC injection

Comparator

PRP or hyaluronic acid

Limitations

Allocation was not randomised for the comparison the title makes. The methods report that BMAC patients were treated sequentially through 2016, and that randomisation began in 2017 between the HA and PRP arms only, once those products were supplied - so the abstract's statement that 175 patients were randomised does not describe the BMAC arm. Markedly unbalanced group sizes (111/34/30), unblinded, single centre, 20 of 195 lost to follow-up. Funded by the Provincial Government of Vojvodina with no conflicts declared.