Department of Sports Medicine, Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A..
Department of Sports Medicine, Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A.
Arthroscopy. 2022 Jul;38(7):2255-2264. doi: 10.1016/j.arthro.2022.01.010. Epub 2022 Jan 15.
To assess the effect of bone marrow aspiration concentrate (BMAC) augmentation on clinical outcomes and magnetic resonance imaging (MRI) findings in anterior cruciate ligament (ACL) reconstruction (ACLR) with bone-patellar tendon-bone (BTB) allografts.
A double-blinded, randomized controlled trial was conducted on 80 patients undergoing ACL reconstruction using BTB allografts. Patients were randomized to 2 groups: (1) bone marrow aspirate was collected from the iliac crest, concentrated, and approximately 2.5 mL was injected into the BTB allograft, or (2) a small sham incision was made at the iliac crest (control). MRI was performed at 3 months and 9 months postoperatively to determine the signal intensity ratio of the ACL graft.
Seventy-three patients were available for follow-up at 1-year postoperatively (36 BMAC, 37 control). International Knee Documentation Committee (IKDC) scores were significantly greater in the BMAC group versus the control at the 9-month postoperative period (81.6 ± 10.5 vs 74.6 ± 14.2, P = .048). There was no significant difference in the proportion of patients who met the minimal clinically important difference for IKDC between the BMAC and control groups at 9 months (89% vs 85%; P = .7). Three months postoperatively, signal intensity ratio of the inferior third of the ACL graft was significantly greater in the BMAC group versus the control group (3.2 ± 2.2 vs 2.1 ± 1.5; P = .02).
Patients who received BMAC augmentation of the BTB allograft during ACL reconstruction demonstrated greater signal intensity scores on MRI at 3 months, suggesting increased metabolic activity and remodeling, and potentially accelerated ligamentization. Additionally, patients in the BMAC group had greater patient-reported outcomes (IKDC) at 9 months postoperatively when compared with those who underwent a standard surgical procedure. There was no significant difference in the proportion of patients who met the minimal clinically important difference for IKDC between the BMAC and control groups at 9 months, suggesting limited clinical significance at this time point.
I, randomized control trial.
评估骨髓抽吸浓缩物（BMAC）增强在前交叉韧带（ACL）重建（ACLR）中对临床结果和磁共振成像（MRI）的影响，使用骨-髌腱-骨（BTB）同种异体移植物。
对 80 例接受 BTB 同种异体移植物 ACLR 的患者进行了一项双盲、随机对照试验。患者随机分为 2 组：（1）从髂嵴采集骨髓抽吸物，浓缩后向 BTB 同种异体移植物中注射约 2.5 毫升，或（2）在髂嵴处进行小的假切口（对照）。术后 3 个月和 9 个月行 MRI 检查，以确定 ACL 移植物的信号强度比。
73 例患者在术后 1 年时可进行随访（BMAC 组 36 例，对照组 37 例）。术后 9 个月时，BMAC 组的国际膝关节文献委员会（IKDC）评分明显高于对照组（81.6±10.5 比 74.6±14.2，P=.048）。9 个月时，BMAC 组和对照组中达到 IKDC 最小临床重要差异的患者比例无显著差异（89%比 85%；P=.7）。术后 3 个月时，BMAC 组的 ACL 移植物下 1/3 的信号强度比明显高于对照组（3.2±2.2 比 2.1±1.5；P=.02）。
在前交叉韧带重建中接受 BTB 同种异体移植物 BMAC 增强的患者在术后 3 个月时 MRI 上的信号强度评分更高，这表明代谢活动和重塑增加，并可能加速韧带化。此外，与接受标准手术的患者相比，BMAC 组的患者在术后 9 个月时的患者报告结局（IKDC）更高。9 个月时，BMAC 组和对照组达到 IKDC 最小临床重要差异的患者比例无显著差异，表明此时点临床意义有限。
I，随机对照试验。
