Two-year Outcome in the Treatment of Knee Osteoarthritis with a Combination of Intraarticular and Intraosseous Autologous Bone Marrow Concentrate

Objective: Safety and therapeutic benefit were assessed for treating knee osteoarthritis with dual intraosseous and intraarticular bone marrow concentrate injections at the two-year milestone. Participant-reported outcomes for Knee Society Score-Knee, Knee Society Score-Function, Lower Extremity Functional Scale, and Visual Analog Scale were assessed, along with Range of Motion and changes in Kellgren-Lawrence Grades.

Methods: Eighteen of 22 knees injected at the start of the study survived to the two-year milestone. The study was performed prospectively at a single site with a single investigator in an open label pilot study with autologous bone marrow concentrate. Each participant received 80% of their bone marrow concentrate in the tibial plateau intraosseous, and 20% intraarticular.

Results: No serious adverse events were attributed to the treatment during the two-year study. Statistically meaningful improvement in mean outcomes and range of motion from baseline to 24-months was observed. Kellgren-Lawrence scores worsened by one level for five knees (29.4%), improved by one level for three knees (17.6%) and were unchanged for nine knees (52.9%). Three study participants progressed to a total knee arthroplasty with an average time to surgery of 16.3 months following treatment.

Conclusion: Safety was demonstrated for the bone marrow concentrate-combined treatment via intraosseous and intraarticular routes for treating Kellgren-Lawrence II-III knee osteoarthritis during the two-year study period. Mean changes at 24-months showed sustained improvement from baseline for range of motion, Knee Society Score-Knee, Knee Society Score-Function, and Visual Analog Scale, although the Lower Extremity Functional Score decreased by 8.8%. Most (70.5%) knees showed no change or an improvement in their Kellgren-Lawrence scores from baseline to the two-year endpoint. These results point to a potential durable benefit in pain mitigation and improved quality of life for patients with knee osteoarthritis who receive bone marrow concentrate via the intraosseous and intraarticular routes for treating knee osteoarthritis.