Bone Marrow Aspirate Concentrate Augmentation May Accelerate Allograft Ligamentization in Anterior Cruciate Ligament Reconstruction: A Double-Blinded Randomized Controlled Trial

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Bone Marrow Aspirate Concentrate Augmentation May Accelerate Allograft Ligamentization in Anterior Cruciate Ligament Reconstruction: A Double-Blinded Randomized Controlled Trial
Address correspondence to Brian Forsythe, M.D., 1611 W. Harrison St., Suite 360, Chicago, IL 60621.
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Published:January 15, 2022DOI: https://doi.org/10.1016/j.arthro.2022.01.010
Next ArticleEditorial Commentary: Bone Marrow Aspirate Concentrate May Accelerate Anterior Cruciate Ligament Allograft Using Bone Patellar Tendon Bone Maturation on Magnetic Resonance Imaging, but Clinical Differences Have Not Been Demonstrated
Purpose
To assess the effect of bone marrow aspiration concentrate (BMAC) augmentation on clinical outcomes and magnetic resonance imaging (MRI) findings in anterior cruciate ligament (ACL) reconstruction (ACLR) with bone–patellar tendon–bone (BTB) allografts.
Methods
A double-blinded, randomized controlled trial was conducted on 80 patients undergoing ACL reconstruction using BTB allografts. Patients were randomized to 2 groups: (1) bone marrow aspirate was collected from the iliac crest, concentrated, and approximately 2.5 mL was injected into the BTB allograft, or (2) a small sham incision was made at the iliac crest (control). MRI was performed at 3 months and 9 months postoperatively to determine the signal intensity ratio of the ACL graft.
Results
Seventy-three patients were available for follow-up at 1-year postoperatively (36 BMAC, 37 control). International Knee Documentation Committee (IKDC) scores were significantly greater in the BMAC group versus the control at the 9-month postoperative period (81.6 ± 10.5 vs 74.6 ± 14.2, P = .048). There was no significant difference in the proportion of patients who met the minimal clinically important difference for IKDC between the BMAC and control groups at 9 months (89% vs 85%; P = .7). Three months postoperatively, signal intensity ratio of the inferior third of the ACL graft was significantly greater in the BMAC group versus the control group (3.2 ± 2.2 vs 2.1 ± 1.5; P = .02).
Conclusions
Patients who received BMAC augmentation of the BTB allograft during ACL reconstruction demonstrated greater signal intensity scores on MRI at 3 months, suggesting increased metabolic activity and remodeling, and potentially accelerated ligamentization. Additionally, patients in the BMAC group had greater patient-reported outcomes (IKDC) at 9 months postoperatively when compared with those who underwent a standard surgical procedure. There was no significant difference in the proportion of patients who met the minimal clinically important difference for IKDC between the BMAC and control groups at 9 months, suggesting limited clinical significance at this time point.
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Published online: January 15, 2022
Accepted: January 6, 2022
Footnotes
See commentary on page 2265
The authors report the following potential conflicts of interest or sources of funding: B.F. reports grants form Arthrex , Stryker , and Smith & Nephew ; royalties or licenses from Elsevier ; consulting fees from Stryker ; and stock or stock options from Jace Medical. J.C. reports consulting fees from Arthrex , CONMED Linvatec , Ossur , and Smith & Nephew ; and board, society, committee or advocacy group for the American Orthopaedic Society for Sports Medicine, the Arthroscopy Association of North America, and the International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine. C.B.C. reports grants from the National Institutes of Health ; and board, society, committee or advocacy group for International Skeletal Society. W.C.B. reports grants from the National Institutes of Health . B.R.B. reports grants from Arthrex , CONMED Linvatec , DJ Orthopaedics , Ossur , Smith & Nephew , and Tornier ; and royalties or licenses from SLACK Inc . B.C. reports grants from Aesculap/B. Braun , Arthrex , Regentis , and National Institutes of Health (NIAMS & NICHD); royalties or licenses from Elsevier ; consulting fees from Regentis , Samumed , and Arthrex ; board, society, committee or advocacy group for American Journal of Orthopedics, American Journal of Sports Medicine, Cartilage, Journal of Shoulder and Elbow Surgery, Journal of the American Academy of Orthopaedic Surgeons, American Journal of Orthopedics, American Journal of Sports Medicine, Cartilage, Arthroscopy Association of North America, and International Cartilage Repair Society; stock or stock options from Bandgrip and Ossio; receipt of equipment, materials, drugs, medical writing, gifts or other services from Operative Techniques in Sports Medicine; and other from Athletico, JRF Ortho, and Smith & Nephew. A.B.Y. reports grants from Arthrex , Vericel , and Organogenesis ; paid consulting fees from CONMED , Linvatec , JRF Ortho , and Olympus ; unpaid consulting fees from PatientIQ , Smith & Nephew , and Sparta Biomedical ; and stock or stock options from PatientIQ. N.V. reports grants from Wright Medical Technology and Breg ; royalties or licenses from Arthroscopy ; consulting fees from Minivasive ; patents (planned, issued, or pending) from Smith & Nephew , instrumentation with royalties paid to Smith & Nephew and American Orthopaedic Society for Sports Medicine ; board, society, committee or advocacy group for American Shoulder and Elbow Surgeons, Arthroscopy Association of North America, Journal of Knee Surgery, and SLACK Inc; stock or stock options from Cymedica and Omeros; receipt of equipment, materials, drugs, medical writing, gifts or other services from Arthroscopy and Vindico Medical-Orthopedics Hyperguide; and personal fees from Arthrex , DJ Orthopaedics , and Orthospace . Full ICMJE author disclosure forms are available for this article online, as supplementary material .
Winner of the Richard O'Connor Research Award from the Arthroscopy Association North American Annual Meeting 2021.
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