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Bone Marrow Aspirate Concentrate Improves Outcomes in Adults With Osteochondral Dissecans of the Talus and Achilles Rupture

Published:December 07, 2022DOI:https://doi.org/10.1016/j.arthro.2022.11.034

      Purpose

      The objective of this systematic literature review was to investigate the effects of the clinical application of bone marrow aspirate (BMA) and/or bone marrow aspirate concentrate (BMAC) in tendon and cartilage injuries in the foot and ankle.

      Methods

      A search of the Embase, MEDLINE/PubMed, CINAHL, and Cochrane databases was performed in January 2021. The risk of bias of the studies was assessed using the tool “A Cochrane Risk of Bias Assessment Tool for Non-Randomized Studies.” The outcomes analyzed included pain reduction and functional improvement with the use of BMA/BMAC in patients with tendon and cartilage injuries in the foot and ankle.

      Results

      Eleven studies met the inclusion criteria for analysis, involving a total of 527 subjects with osteochondral lesions (OCLs) of the talus, cartilage lesions of the talus, and acute Achilles tendon rupture. BMAC was applied alone in 4 studies, and in 7 studies, it was compared with other techniques such as matrix-induced autologous chondrocyte implantation, particulate juvenile articular cartilage, or microfracture. Interventions demonstrated improved function and reduced foot and ankle pain and showed no serious adverse effects.

      Conclusions

      Evidence indicates that BMAC provides good clinical results, with improved function and reduced pain in adults with OCL and cartilage lesions of the talus and acute Achilles tendon rupture.

      Level of Evidence

      Level IV, systematic review of level II to IV studies.
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      References

        • Frecklington M.
        • Dalbeth N.
        • McNair P.
        • et al.
        Footwear interventions for foot pain, function, impairment and disability for people with foot and ankle arthritis: A literature review.
        Semin Arthritis Rheum. 2018; 47: 814-824
        • Godoy-Santos A.L.
        • Schepers T.
        Soft Tissue Foot & Ankle Group. Soft-tissue injury to the foot and ankle: Literature review and staged management protocol.
        Acta Ortop Bras. 2019; 27: 223-229
        • Gorbachova T.
        Magnetic resonance imaging of the ankle and foot.
        Pol J Radiol. 2020; 85: e532-e549
        • Cottom J.M.
        • Plemmons B.S.
        Bone marrow aspirate concentrate and its uses in the foot and ankle.
        Clin Podiatr Med Surg. 2018; 35: 19-26
        • Dombrowski M.E.
        • Yasui Y.
        • Murawski C.D.
        • et al.
        Conservative management and biological treatment strategies: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle.
        Foot Ankle Int. 2018; 39: 9S-15S
        • Savage-Elliott I.
        • Ross K.A.
        • Smyth N.A.
        • Murawski C.D.
        • Kennedy J.G.
        Osteochondral lesions of the talus: A current concepts review and evidence-based treatment paradigm.
        Foot Ankle Spec. 2014; 7: 414-422
        • Robinson P.G.
        • Murray I.R.
        • Maempel J.
        • Rankin C.S.
        • Hamilton D.
        • Gaston P.
        Use of biologics as an adjunct therapy to arthroscopic surgery for the treatment of femoroacetabular impingement: A systematic review.
        Orthop J Sports Med. 2019; 72325967119890673
        • Burnham T.
        • Conger A.
        • Tate Q.
        • et al.
        The effectiveness and safety of percutaneous platelet-rich plasma and bone marrow aspirate concentrate for the treatment of suspected discogenic low back pain: A comprehensive review.
        Curr Phys Med Rehabil Rep. 2019; 7: 372-384
        • Blanton C.M.
        • Clougherty C.O.
        The role of bone marrow aspirate in osseous and soft tissue pathology.
        Clin Podiatr Med Surg. 2021; 38: 1-16
        • Gaul F.
        • Bugbee W.D.
        • Hoenecke H.R.
        • D’Lima D.D.
        A review of commercially available point-of-care devices to concentrate bone marrow for the treatment of osteoarthritis and focal cartilage lesions.
        Cartilage. 2019; 10: 387-394
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.G.
        • PRISMA Group
        Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement.
        Int J Surg. 2010; 8: 336-341
        • Milner K.A.
        • Cosme S.
        The PICO game: An innovative strategy for teaching step 1 in evidence-based practice.
        Worldviews Evid Based Nurs. 2017; 14: 514-516
        • Ouzzani M.
        • Hammady H.
        • Fedorowicz Z.
        • Elmagarmid A.
        Rayyan—a web and mobile app for systematic reviews.
        Syst Rev. 2016; 5: 210
        • Sterne J.A.
        • Hernán M.A.
        • Reeves B.C.
        • et al.
        ROBINS-I: A tool for assessing risk of bias in non-randomised studies of interventions.
        BMJ. 2016; 355: i4919
        • Balshem H.
        • Helfand M.
        • Schünemann H.J.
        • et al.
        GRADE guidelines: 3. Rating the quality of evidence.
        J Clin Epidemiol. 2011; 64: 401-406
        • Guyatt G.
        • Oxman A.D.
        • Akl E.A.
        • et al.
        GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables.
        J Clin Epidemiol. 2011; 64: 383-394
        • Chan J.J.
        • Guzman J.Z.
        • Vargas L.
        • Myerson C.L.
        • Chan J.
        • Vulcano E.
        Safety and effectiveness of talus subchondroplasty and bone marrow aspirate concentrate for the treatment of osteochondral defects of the talus.
        Orthopedics. 2018; 41: e734-e737
        • DeSandis B.A.
        • Haleem A.M.
        • Sofka C.M.
        • O’Malley M.J.
        • Drakos M.C.
        Arthroscopic Treatment of osteochondral lesions of the talus using juvenile articular cartilage allograft and autologous bone marrow aspirate concentration.
        J Foot Ankle Surg. 2018; 57: 273-280
        • Desando G.
        • Bartolotti I.
        • Vannini F.
        • et al.
        Repair potential of matrix-induced bone marrow aspirate concentrate and matrix-induced autologous chondrocyte implantation for talar osteochondral repair.
        Cartilage. 2017; 8: 50-60
        • Hannon C.P.
        • Ross K.A.
        • Murawski C.D.
        • et al.
        Arthroscopic bone marrow stimulation and concentrated bone marrow aspirate for osteochondral lesions of the talus: A case-control study of functional and magnetic resonance observation of cartilage repair tissue outcomes.
        Arthroscopy. 2016; 32: 339-347
        • Karnovsky S.C.
        • DeSandis B.
        • Haleem A.M.
        • Sofka C.M.
        • O’Malley M.
        • Drakos M.C.
        Comparison of juvenile allogenous articular cartilage and bone marrow aspirate concentrate versus microfracture with and without bone marrow aspirate concentrate in arthroscopic treatment of talar osteochondral lesions.
        Foot Ankle Int. 2018; 39: 393-405
        • Kennedy J.G.
        • Murawski C.D.
        The treatment of osteochondral lesions of the talus with autologous osteochondral transplantation and bone marrow aspirate concentrate: Surgical technique.
        Cartilage. 2011; 2: 327-336
        • Lanham N.S.
        • Carroll J.J.
        • Cooper M.T.
        • Perumal V.
        • Park J.S.
        A comparison of outcomes of particulated juvenile articular cartilage and bone marrow aspirate concentrate for articular cartilage lesions of the talus.
        Foot Ankle Specialist. 2017; 10: 315-321
        • Murphy E.P.
        • McGoldrick N.P.
        • Curtin M.
        • Kearns S.R.
        A prospective evaluation of bone marrow aspirate concentrate and microfracture in the treatment of osteochondral lesions of the talus.
        Foot Ankle Surg. 2019; 25: 441-448
        • Shimozono Y.
        • Yasui Y.
        • Hurley E.T.
        • Paugh R.A.
        • Deyer T.W.
        • Kennedy J.G.
        Concentrated bone marrow aspirate may decrease postoperative cyst occurrence rate in autologous osteochondral transplantation for osteochondral lesions of the talus.
        Arthroscopy. 2019; 35: 99-105
        • Stein B.E.
        • Stroh D.A.
        • Schon L.C.
        Outcomes of acute Achilles tendon rupture repair with bone marrow aspirate concentrate augmentation.
        Int Orthop. 2015; 39: 901-905
        • Tahta M.
        • Akkaya M.
        • Gursoy S.
        • Isik C.
        • Bozkurt M.
        Arthroscopic treatment of osteochondral lesions of the talus: Nanofracture versus hyaluronic acid-based cell-free scaffold with concentration of autologous bone marrow aspirate.
        J Orthop Surg. 2017; 25230949901771787
        • Drakos M.C.
        • Eble S.K.
        • Cabe T.N.
        • et al.
        Comparison of functional and radiographic outcomes of talar osteochondral lesions repaired with micronized allogenic cartilage extracellular matrix and bone marrow aspirate concentrate vs microfracture.
        Foot Ankle Int. 2021; 42: 841-850
        • Kim G.B.
        • Seo M.S.
        • Park W.T.
        • Lee G.W.
        Bone marrow aspirate concentrate: Its uses in osteoarthritis.
        IJMS. 2020; 21: 3224
        • Shapiro S.A.
        • Kazmerchak S.E.
        • Heckman M.G.
        • Zubair A.C.
        • O’Connor M.I.
        A prospective, single-blind, placebo-controlled trial of bone marrow aspirate concentrate for knee osteoarthritis.
        Am J Sports Med. 2017; 45: 82-90
        • Imam M.A.
        • Holton J.
        • Horriat S.
        • et al.
        A systematic review of the concept and clinical applications of bone marrow aspirate concentrate in tendon pathology.
        SICOT-J. 2017; 3: 58
        • Imam M.A.
        • Mahmoud S.S.S.
        • Holton J.
        • Abouelmaati D.
        • Elsherbini Y.
        • Snow M.
        A systematic review of the concept and clinical applications of bone marrow aspirate concentrate in orthopaedics.
        Sicot-J. 2017; 3: 17
        • Cavinatto L.
        • Hinckel B.B.
        • Tomlinson R.E.
        • Gupta S.
        • Farr J.
        • Bartolozzi A.R.
        The role of bone marrow aspirate concentrate for the treatment of focal chondral lesions of the knee: A systematic review and critical analysis of animal and clinical studies.
        Arthroscopy. 2019; 35: 1860-1877
        • Murray I.R.
        • Robinson P.G.
        • West C.C.
        • et al.
        Reporting standards in clinical studies evaluating bone marrow aspirate concentrate: A systematic review.
        Arthroscopy. 2018; 34: 1366-1375https://doi.org/10.1016/j.arthro.2017.11.036
        • Cotter E.J.
        • Wang K.C.
        • Yanke A.B.
        • Chubinskaya S.
        Bone marrow aspirate concentrate for cartilage defects of the knee: From bench to bedside evidence.
        Cartilage. 2018; 9: 161-170
        • Everts P.A.
        • Malanga G.A.
        • Paul R.V.
        • Rothenberg J.B.
        • Stephens N.
        • Mautner K.R.
        Assessing clinical implications and perspectives of the pathophysiological effects of erythrocytes and plasma free hemoglobin in autologous biologics for use in musculoskeletal regenerative medicine therapies: A review.
        Regenerative Therapy. 2019; 11: 56-64