Park Jae Yong, Ng Hing Cheung James Andrew, Todorov Dominik, Park Shin Young, Lim Hayeon, Shin Eunjae, Yoon Angelina, Ha Joon
Faculty of Medicine, Imperial College London, Ayrton Rd, South Kensington, London, SW7 5NH, UK.
Faculty of Medicine, Manchester University, Manchester, UK.
Int Orthop. 2025 Jan;49(1):35-43. doi: 10.1007/s00264-024-06380-5. Epub 2024 Nov 22.
Biological augmentation of anterior cruciate ligament (ACL) reconstruction with bone marrow aspirate concentrate (BMAC) is gaining attention for its theoretical potential to enhance postoperative healing and recovery. However, its clinical benefits remain uncertain, and its high cost raises questions about efficacy. Hence, we systematically reviewed randomised controlled trials (RCTs) to evaluate the effectiveness of BMAC in ACL reconstruction.
Our search included Cochrane, EMBASE, OVID, PubMed, and Scopus databases for RCTs evaluating the use of BMAC in ACL reconstruction. Primary outcomes focused on International Knee Documentation Committee (IKDC) scores and Lysholm scores. Secondary outcomes included MRI-related outcomes and postoperative complications. Statistical analysis was conducted using Review Manager 5.4 (Cochrane Collaboration), with heterogeneity assessed using Cochrane's Q test and I statistics.
221 patients from five RCTs were included, with 109 (49.3%) receiving BMAC augmentation. Follow-up ranged from 11.05 to 24 months. No significant differences were found in postoperative IKDC scores between the BMAC and control groups at, three, six and 12 months. The BMAC group had significantly higher IKDC scores at 24 months; however, this difference was unlikely to be clinically significant. No significant differences were observed in postoperative Lysholm scores at 12 or 24 months. MRI-related outcomes suggested potential graft recovery improvement with BMAC, and complication rates were comparable between groups.
In summary, biological augmentation with BMAC in ACL reconstruction does not significantly improve early patient-reported outcomes but offers potential benefits in graft recovery without increasing complication rates.
采用骨髓抽吸浓缩物（BMAC）对前交叉韧带（ACL）重建进行生物学增强，因其在理论上具有促进术后愈合和恢复的潜力而受到关注。然而，其临床益处仍不确定，且成本高昂引发了对其疗效的质疑。因此，我们系统回顾了随机对照试验（RCT），以评估BMAC在ACL重建中的有效性。
我们在Cochrane、EMBASE、OVID、PubMed和Scopus数据库中检索评估BMAC在ACL重建中应用的RCT。主要结局指标聚焦于国际膝关节文献委员会（IKDC）评分和Lysholm评分。次要结局指标包括与MRI相关的结局和术后并发症。使用Review Manager 5.4（Cochrane协作网）进行统计分析，采用Cochrane的Q检验和I统计量评估异质性。
纳入了来自5项RCT的221例患者，其中109例（49.3%）接受了BMAC增强。随访时间为11.05至24个月。BMAC组和对照组在术后3个月、6个月和12个月时的IKDC评分无显著差异。BMAC组在24个月时的IKDC评分显著更高；然而，这种差异在临床上不太可能具有显著意义。在术后12个月或24个月时，Lysholm评分无显著差异。与MRI相关的结局表明BMAC可能改善移植物恢复情况，且两组间并发症发生率相当。
总之，在ACL重建中使用BMAC进行生物学增强并不能显著改善早期患者报告的结局，但在不增加并发症发生率的情况下，对移植物恢复具有潜在益处。
