title: Concentrated Bone Marrow Aspirate for the Treatment of Chondral Injuries and Osteoarthritis of the Knee: A Systematic Review of Outcomes.
abstract: BACKGROUND
  Bone marrow aspirate concentrate (BMAC) has emerged as a novel treatment for pathology of the knee. Despite containing a limited number of stem cells, BMAC serves as a source of growth factors that are thought to play an important role as a result of their anabolic and anti-inflammatory effects. To our knowledge, there is no systematic review regarding the outcomes of bone marrow aspirate concentrate used for the treatment of chondral defects and osteoarthritis of the knee.
  
  
  OBJECTIVE
  To perform a systematic review on the outcomes of bone marrow aspirate concentrate for the treatment of chondral defects and osteoarthritis of the knee.
  
  
  METHODS
  Systematic review; Level of evidence, 4.
  
  
  METHODS
  A systematic review of the literature was performed using the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed, and MEDLINE from 1980 to present. Inclusion criteria were as follows: use of BMAC for treatment of chondral defects and osteoarthritis of the knee, English language, and human studies. We excluded cadaveric studies, animal studies, basic science articles, editorial articles, surveys, and studies that did not include the knee. After applying inclusion and exclusion criteria, studies were evaluated for efficacy and safety of BMAC for treatment of articular cartilage knee pathologies.
  
  
  RESULTS
  Eleven studies were considered. Of these, 5 were prospective studies, 1 was a retrospective study, 2 were case series, and 3 were case reports. Three comparative studies (2 with level 2 evidence, 1 with level 3 evidence) were found in our search; none of them were randomized. Three studies investigated the clinical efficacy of BMAC in the treatment of osteoarthritis, and 8 studies evaluated the efficacy of BMAC on focal cartilage injuries. All 3 studies regarding osteoarthritis and all 8 studies regarding focal chondral defects reported good to excellent overall outcomes with the use of BMAC.
  
  
  CONCLUSIONS
  Although a growing interest for biological alternatives of treating knee pathology has been observed in the past few years, there still remains a paucity of high-quality studies. The studies included in this systematic review reported varying degrees of beneficial results with the use of BMAC with and without an additional procedure for the treatment of chondral defects and early stages of osteoarthritis. Most articles present the use of BMAC as a safe procedure and report good results.
authors.affiliation: Steadman Philippon Research Institute, Vail, Colorado, USA.
authors.forename: Jorge
authors.initials: J
authors.lastname: Chahla
authors.affiliation: Steadman Philippon Research Institute, Vail, Colorado, USA.
authors.forename: Chase S
authors.initials: CS
authors.lastname: Dean
authors.affiliation: Steadman Philippon Research Institute, Vail, Colorado, USA.; Oslo University Hospital, Oslo, Norway.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Moatshe
authors.affiliation: University of Colorado, Denver, Colorado, USA.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Pascual-Garrido
authors.affiliation: Steadman Philippon Research Institute, Vail, Colorado, USA.; Instituto Brasil de Tecnologias da Saúde, Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Raphael
authors.initials: R
authors.lastname: Serra Cruz
authors.affiliation: Steadman Philippon Research Institute, Vail, Colorado, USA.; The Steadman Clinic, Vail, Colorado, USA.
authors.forename: Robert F
authors.initials: RF
authors.lastname: LaPrade
keywords: BMAC; bone marrow aspirate concentrate; cartilage; knee; regenerative therapy; systematic review