Aim: To develop a simple clinical decision rule (CDR) to identify people with knee osteoarthritis who are likely or unlikely to benefit from bone marrow aspirate concentrate (BMAC) injection. Materials & methods: A total of 92 people with clinical and radiographic evidence of refractory knee osteoarthritis received a single intra-articular (IA) BMAC injection. Multiple logistic regression analysis was used to determine which combination of risk factors predicted BMAC responsiveness. A responder was defined as a person whose knee pain improved more than 15% from baseline 6 months post procedure. Results: The CDR demonstrated that those with lower pain levels, or high pain levels with previous surgery, could be predicted to benefit from a single IA BMAC injection. Conclusion: A simple CDR containing three variables predicted responsiveness to a single IA knee BMAC injection with high accuracy. Further validation of the CDR is required prior to routine use in clinical practice.

Plain language summary

People with knee osteoarthritis who do not improve with exercise and medicine lack effective long-term treatment options apart from total knee replacement. Although total knee replacement provides effective outcomes in most people, not all people are candidates and not all people respond. Thus, other safe and effective treatment options are required. Bone marrow aspirate concentrate (BMAC) is a regenerative medicine treatment that has demonstrated success in people with chronic knee osteoarthritis. However, it is unclear which people do or do not respond to BMAC. This study investigated factors that predicted a successful response to a single injection of BMAC 6 months post injection. Those with lower initial pain levels (<7/10), or high pain levels with previous surgery, could be predicted to benefit from a single BMAC injection.

Keywords:

Papers of special note have been highlighted as: • of interest

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Vol. 18, No. 6

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History

Received 21 January 2023

Accepted 3 May 2023

Published online 21 May 2023

Published in print June 2023

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Keywords

Author contributions

AD Smith: substantial contributions to the conception or design of the work; or the acquisition, analysis or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. D Sydora: substantial contributions to the conception or design of the work; or the acquisition, analysis or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. R Burnham: substantial contributions to the conception or design of the work; or the acquisition, analysis or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Acknowledgments

We wish to acknowledge D Hart (Department of Surgery & Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada; Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada) for his suggestion to pursue this manuscript.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The authors state that they have obtained appropriate institutional review board approval or have followed the principles outlined in the Declaration of Helsinki for all human or animal experimental investigations. In addition, for investigations involving human subjects, informed consent has been obtained from the participants involved.

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