Summary

Level II cohort study of consecutive patients managed with or without bone marrow aspiration concentrate augmentation (BMAC) during ACL reconstruction. At 6 months follow-up, BMAC did not improve graft maturation as seen on magnetic resonance imaging, and did not show differences for functional outcomes at 6 months, 12, and 30-month follow-up.

Abstract

Background

There is ambiguous recent evidence regarding the use of healing adjuvants during anterior cruciate ligament reconstructions (ACL-R) procedures. Bone marrow aspiration concentrate (BMAC) has been proposed as a safe and potentially healing stimulation aid in animal models; however, clinical evidence is still scarce and controversial regarding imaging and functional results.

Purpose

Evaluate the imaging and functional outcomes of BMAC augmentation in ACL-R.

Methods

Cohort nonrandomized study in patients treated for primary ACL rupture using an autologous hamstring graft. Patients with multiligamentary knee injuries and revision surgeries were excluded. Two study groups were analyzed: Intervention (BMAC) and Control. Both groups were compared for operative times, graft maturation (magnetic resonance at 6 months from surgery), and functional outcomes (isokinetic tests at 6 months from surgery, and KOOS, IKDC, Lysholm, and Tegner at 0, 6, 12, and 30 months). BMAC was obtained from the intercondylar femoral notch during the reconstruction procedure.

Results

Forty-nine patients were selected (30 Intervention/19 Control). Both groups were comparable for age (p=0.845), sex (p=0.711), body mass index (p=0.121), and all pre-operative functional scores, except for a higher KOOS (Function in sport and recreation) in the Control group (p=0.035). Two (6.67%) and two (10.5%) patients from Intervention and Control group, respectively, lost follow-up at 30 months from surgery (p=0.548).
Operative times: The Intervention group showed significantly higher operative times than the Control group [63 minutes (48-90)/50 minutes (38-72); p<0.001].
Graft maturation: No differences regarding graft maturation were observed for tunnel integration (p=0.498; p=0.954) and graft ligamentization (p=0.582) between groups.
Isokinetic tests: No differences between groups in muscle deficit at 6 months, for both extensor [36% (11-68)/ 32% (15-73); p=0.339] and flexor muscles [15% (2-46)/14% (7-34); p=0.875].
Functional scores: No differences at 6, 12, and 30 months from surgery between groups. Both groups showed significant improvements between baseline and 6 months (p<0.001), and between 6 and 12 months (p<0.001).

Conclusion

BMAC did not improve ACL-R graft maturation and isokinetic tests at 6 months of follow-up, nor functional outcomes at 6, 12, and 30 months from surgery compared to a Control group; however, it increased operative time.