Autologous Bone Marrow Aspirate Concentrate in Patients Undergoing Meniscectomy
Study Details
Study Description
Brief Summary
The proposed research study aims to evaluate the effects of autologous bone marrow aspirate concentrate (BMAC) on the development and progression of osteoarthritis (OA) in patients undergoing meniscectomy. This prospective, randomized, double-blind clinical trial will compare patient-reported outcomes, specifically IKDC scores between patients who receive BMAC post-meniscectomy and those who receive a saline control injection. The study will also compare physical examination, MRI, radiographs, and synovial fluid analysis. Our hypothesis is that those who receive the autologous BMAC injection after the procedure will have better outcomes than those who do not.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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N/A |
Detailed Description
Recent studies have demonstrated both the safety of BMAC intra-articular injection and improvements in subjective, patient reported outcomes in patients with existing knee OA. Unfortunately these studies were largely uncontrolled, underpowered, and/or retrospective in nature. Additionally, a recent prospective, randomized clinical study of allograft mesenchymal stem cells (MSCs) injected at a separate time point post surgical intervention has highlighted the ability of MSCs to increase meniscal volume and improve knee pain following injection.
This will be the first study to examine the effects of autograft BMAC intra-articular injection in a single-stage procedure and in a prospective, randomized, double-blind fashion. The results of this study, if the null hypothesis is rejected, will have far-reaching implications for the standard of care in meniscal treatment and on OA progression in the knee. Additionally, if the results of this study are favorable in reduction of OA progression this study will change the surgical approach to all axial, synovial joints including the shoulder, elbow, wrist, hip, and ankle.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Meniscectomy with Bone Marrow Aspirate Concentrate (BMAC) Subjects will undergo the scheduled meniscectomy procedure. Following the procedure the investigator will make a small incision and create the marrow access channel in the proximal tibia. The experimental group will then have bone marrow harvested and BMAC will be prepared using a BMAC harvesting system. The automated centrifuge system rapidly concentrates cellular contents and growth factors in bone marrow aspirate using flow cytometry. The BMAC will be injected intra-articularly. |
Biological: Bone Marrow Aspirate Concentrate
Subjects undergoing autologous bone marrow aspirate concentrate will receive an intra-articular injection into the affected knee.
Procedure: Standard Meniscectomy
All subjects will undergo either a partial or complete meniscectomy to treat the torn meniscus.
|
| Placebo Comparator: Meniscectomy with Placebo Subjects will undergo the same meniscectomy procedure and will also have an incision and marrow access channel made in the proximal tibia, however no bone marrow will be harvested. The control group will have a placebo injection of saline into the affected knee. |
Procedure: Standard Meniscectomy
All subjects will undergo either a partial or complete meniscectomy to treat the torn meniscus.
|
Outcome Measures
Primary Outcome Measures
- International Knee Documentation Committee (IKDC) Score [One Year]
The primary outcome measure will be the IKDC score at one year follow-up
Secondary Outcome Measures
- Patient reported outcomes throughout follow-up period [7-10 days, 6 weeks, 3 months, 6 months, 1 year, 2 years]
Patient reported outcomes will include change in scores from preoperative to Postoperative Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)
- Synovial fluid analysis [2 weeks, 6 weeks]
To investigate any changes in synovial fluid markers of osteoarthritis.
- Radiographic analysis [1 year, 2 years]
The degree of OA will be examined in all patients preoperatively and at subsequent follow-up visits at 1 and 2 years.
- Patient reported outcomes throughout follow-up period [7-10 days, 6 weeks, 3 months, 6 months, 1 year, 2 years]
Visual Analog Score (VAS)
- Patient reported outcomes throughout follow-up period [7-10 days, 6 weeks, 3 months, 6 months, 1 year, 2 years]
International Knee Documentation Committee form (IKDC)
- Patient reported outcomes throughout follow-up period [7-10 days, 6 weeks, 3 months, 6 months, 1 year, 2 years]
Knee injury and Osteoarthritis Outcome Score (KOOS)
- Patient reported outcomes throughout follow-up period [7-10 days, 6 weeks, 3 months, 6 months, 1 year, 2 years]
(Short Form Health Survey) SF-12
Eligibility Criteria
Criteria
Inclusion Criteria:
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Subject is greater than 18 years old
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Written informed consent is obtained
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Subject is determined to have a symptomatic meniscal tear requiring a meniscectomy
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Meniscal pathology is confirmed through MRI and arthroscopically
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Subject agrees to all follow-up evaluations
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Osteoarthritis Kellen-Lawrence grade 1-3 on flexion PA and extension AP views
Exclusion Criteria:
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Any subject lacking decisional capability
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Unwillingness to participate in the necessary follow-up
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Subject is pregnant or may become pregnant
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History of diabetes mellitus
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History of rheumatoid arthritis or other autoimmune disorder
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History of solid organ or hematologic transplantation
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Diagnosis of a non-basal cell malignancy within the preceding 5 years
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Infection requiring antibiotic treatment within the preceding 3 months
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Osteoarthritis Kellen-Lawrence grade 4 on flexion posterior-anterior (PA) or extension anteroposterior (AP) views
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Prior surgery on the index meniscus
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Concomitant surgery such as ligament surgery or cartilage repair or restoration
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Infection
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Prior cortisone/viscosupplementation/ (platelet rich plasma) PRP injection within 6 weeks
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Rush University Medical Center | Chicago | Illinois | United States | 60612 |
Sponsors and Collaborators
- Rush University Medical Center
Investigators
- Principal Investigator: Brian J Cole, MD, MBA, Midwest Orthopaedics at Rush
Study Documents (Full-Text)
None provided.More Information
Publications
- Centeno C, Pitts J, Al-Sayegh H, Freeman M. Efficacy of autologous bone marrow concentrate for knee osteoarthritis with and without adipose graft. Biomed Res Int. 2014;2014:370621. doi: 10.1155/2014/370621. Epub 2014 Sep 7.
- Enea D, Cecconi S, Calcagno S, Busilacchi A, Manzotti S, Gigante A. One-step cartilage repair in the knee: collagen-covered microfracture and autologous bone marrow concentrate. A pilot study. Knee. 2015 Jan;22(1):30-5. doi: 10.1016/j.knee.2014.10.003. Epub 2014 Nov 20.
- Fortier LA, Potter HG, Rickey EJ, Schnabel LV, Foo LF, Chong LR, Stokol T, Cheetham J, Nixon AJ. Concentrated bone marrow aspirate improves full-thickness cartilage repair compared with microfracture in the equine model. J Bone Joint Surg Am. 2010 Aug 18;92(10):1927-37. doi: 10.2106/JBJS.I.01284.
- Gobbi A, Karnatzikos G, Scotti C, Mahajan V, Mazzucco L, Grigolo B. One-Step Cartilage Repair with Bone Marrow Aspirate Concentrated Cells and Collagen Matrix in Full-Thickness Knee Cartilage Lesions: Results at 2-Year Follow-up. Cartilage. 2011 Jul;2(3):286-99. doi: 10.1177/1947603510392023.
- Kim JD, Lee GW, Jung GH, Kim CK, Kim T, Park JH, Cha SS, You YB. Clinical outcome of autologous bone marrow aspirates concentrate (BMAC) injection in degenerative arthritis of the knee. Eur J Orthop Surg Traumatol. 2014 Dec;24(8):1505-11. doi: 10.1007/s00590-013-1393-9. Epub 2014 Jan 8.
- Vangsness CT Jr, Farr J 2nd, Boyd J, Dellaero DT, Mills CR, LeRoux-Williams M. Adult human mesenchymal stem cells delivered via intra-articular injection to the knee following partial medial meniscectomy: a randomized, double-blind, controlled study. J Bone Joint Surg Am. 2014 Jan 15;96(2):90-8. doi: 10.2106/JBJS.M.00058.
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