AJSM - 2026-06-01 - Journal Article; Randomized Controlled Trial
Bone Marrow Aspirate Concentrate Improves the Early Osseous Integration of Fresh Osteochondral Allografts in the Knee: A Randomized Controlled Trial.
Gelber PE, Ramírez-Bermejo E, Caviasso G, Juncosa-Chacón J, Fariñas O
Topics
Key Takeaway
BMAC augmentation improved CT-assessed host-graft junction integration at 3 months post-FOCA transplantation (p<0.05), but this advantage disappeared by 6 and 12 months with no difference in any patient-reported outcome at 2 years.
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Summary
This single-center RCT asked whether BMAC augmentation improves osseous integration and clinical outcomes in FOCA transplantation of the knee. CT using the ACTOCA scoring system showed superior host-graft junction integration in the BMAC group at 3 months only, with the non-BMAC group demonstrating better graft signal density at 12 months. IKDC, Kujala, WOMAC, and Tegner scores were equivalent between groups at all time points through 24 months.
Key Limitation
The trial is critically underpowered at n=36 to detect differences in PROs, and the unexpected reversal of graft signal density advantage to the non-BMAC group at 12 months is unexplained and may reflect BMAC interference with normal allograft remodeling.
Original Abstract
BACKGROUND
Fresh osteochondral allograft (FOCA) transplantation is an increasingly used technique for treating symptomatic cartilage defects in young and active patients. However, insufficient osseous integration of the graft remains a primary cause of failure. Bone marrow aspirate concentrate (BMAC), rich in mesenchymal stem cells, may enhance graft integration.
PURPOSE
To determine whether the use of autologous BMAC in FOCA transplantation of the knee improves osseous integration on computed tomography (CT) during the first postoperative year and yields superior clinical outcomes compared to non-BMAC-treated grafts at 2-year follow-up.
STUDY DESIGN
Randomized clinical trial; Level of evidence, 1.
METHODS
We conducted a single-center, prospective, randomized controlled trial in 36 patients undergoing FOCA transplantation. Patients who met the inclusion criteria were randomly assigned to either a BMAC group or non-BMAC group. CT was performed at 3, 6, and 12 months, and imaging findings were evaluated using the semiquantitative assessment CT osteochondral allograft (ACTOCA) scoring system. Clinical outcomes (International Knee Documentation Committee, Kujala, Western Ontario Meniscal Evaluation Tool, and Tegner scores) were assessed preoperatively and at 6, 12, and 24 months.
RESULTS
Osseous integration at the host-graft junction on CT was superior in the BMAC group at 3 months postoperatively compared with the non-BMAC group ( P < .05), with no differences between groups at 6 or 12 months. Regarding graft signal density relative to host bone, differences were observed between groups at 3 and 12 months, with better 3-month graft signaling in the BMAC group and better 12-month graft signaling in the non-BMAC group. No differences were observed at 6 months. Also, no differences were observed between groups in patient-reported outcome scores.
CONCLUSION
BMAC augmentation in FOCA transplantation of the knee demonstrated improved early osseous integration at the host-graft junction at 3 months postoperatively, as assessed on CT using the ACTOCA scoring system, with no differences observed at 6 or 12 months. Regarding graft signal density relative to host bone, significant differences were observed at 3 and 12 months, with better 3-month graft signaling in the BMAC group and better 12-month graft signaling in the non-BMAC group. No differences were observed between groups in patient-reported outcome scores.
REGISTRATION
NCT04236492 (ClinicalTrials.gov).