Ross Hauser, MD; Danielle Matias, PA-C; Demi Foster, APRN
In 2013 Caring Medical published: “Regenerative injection therapy with whole bone marrow aspirate for degenerative joint disease: a case series” In the journal Clinical medicine insights. Arthritis and musculoskeletal disorders. In this paper we presented the cases of seven patients.
A May 2026 study published in the Journal of orthopaedic surgery and research (1) aimed to evaluate the efficacy of autologous bone marrow aspirate concentrate (BMAC) injections into patients with knee osteoarthritis and associated bone abnormalities. The researchers hypothesized that this treatment would yield significant improvements in pain relief and functional mobility at one year post-treatment.
Furthermore, the study sought to determine whether these clinical improvements could be detected via MRI imaging at three months and to assess if patient age or body mass index influenced outcomes.
Bone marrow aspirate was harvested from the iliac crest, processed, and injected into the affected knee under fluoroscopic guidance. Primary endpoints were pain and functional scores collected at baseline, 1, 3, 6, and 12 months post-intervention. MRI assessments focused on bone abnormalities at baseline and three months. Statistical analyses were performed to confirm the significance of observed changes.
A total of 62 participants enrolled, with a mean age of approximately 58 years, and slightly more than half were female. The mean BMI was 24. All subjects completed the 12-month follow-up.
Post-treatment, patients demonstrated substantial improvements in pain and functional outcome measures compared to baseline values. All primary metrics showed marked enhancement. MRI evaluations indicated significant amelioration of bone abnormalities at three months. Notably, participants with a BMI below 24 exhibited superior pain reduction after one year and greater improvement in bone pathology at three months. Additionally, individuals aged 60 years or younger experienced more rapid pain relief at one month compared to those over 70 years of age.
A May 2024 study published by Indian researchers in the Indian journal of orthopaedics (2) examined the effectiveness of bone marrow aspirate concentrate injections in 63 patients with grade II-III knee osteoarthritis. These patients were considered unresponsive to conservative treatment methods. The general assessment after 24 months was that bone marrow aspirate concentrate injections provided significant improvement in both pain and functional outcomes at mid-term follow-up in patients with mild-to-moderate osteoarthritis of the knee. Because of the limited study size, the study authors called for further studies with more patients and longer follow-up necessary to justify the routine clinical use of bone marrow aspirate concentrate for treatment of patients suffering with knee osteoarthritis.
A November 2024 study (3) in the Indian journal of orthopaedics examined the impact of obesity and being overweight on the effectiveness of a single bone marrow concentrate injection into patients with early stage knee osteoarthritis.
The researchers grouped 68 patients into normal, overweight, and obese groups based on the patient’s body mass index. Visual Analog Scale (VAS) for pain and Knee Injury and Osteoarthritis Outcome Score (KOOS) were the outcomes analyzed.
- Sixty-eight patients (normal BMI = 43, overweight BMI = 15, obese BMI = 10) were enrolled in the study for analysis.
- While significant improvement in the outcome scores was noted compared to the baseline throughout the study period in the normal BMI and overweight group, the obese group returned to baseline parameters at 3 months follow-up.
- Patients in the normal BMI group demonstrated significant improvement in VAS and KOOS outcomes compared to the overweight and obese group.
A December 2024 study in the Orthopaedic journal of sports medicine (4) investigated the clinical effectiveness of Bone marrow aspirate concentrate injections for knee osteoarthritis compared with other injection treatments.
- Eight studies, consisting of a total of 937 patients, were included.
- Patients treated with bone marrow aspirate concentrate injections showed a significant improvement in clinical (pain and functional improvement) scores compared with baseline, starting at 1 month post-injection.
- For pain scores at 6-month and 12-month follow-up bone marrow aspirate concentrate demonstrated favorable results over Hyaluronic acid, with a statistically significant difference. However, these differences did not exceed the minimal clinically important difference (suggesting a more significant result than another treatment). When bone marrow aspirate concentrate was compared with other injections, no significant differences were observed in the degree of clinical score improvement.
Our published research
The regeneration of articular cartilage with prolotherapy | Caring Medical Research
References
1 Ezzi SH, Ding H, Wu S, Malik MA, Alshabi MM, Zhang W, Cao X, Huang J. Subchondral bone marrow aspirate concentrate injection improves clinical outcomes and reduces bone marrow lesions in knee osteoarthritis: 12-month retrospective analysis. Journal of Orthopaedic Surgery and Research. 2026 May 14. [Google Scholar]
2 Jeyaraman M, Jeyaraman N, Ramasubramanian, S, Ranjan R., Jha S.K. and Gupta, A., 2024. Bone Marrow Aspirate Concentrate for Treatment of Primary Knee Osteoarthritis: A Prospective, Single-Center, Non-randomized Study with 2-Year Follow-Up. Indian Journal of Orthopaedics, pp.1-11. [Google Scholar]
3 Muthu S, Thangavel P, Duraisamy S, Jha SK, Ramanathan K, Alagar Yadav S, Ranjan R. Obese Patients Do Not Benefit from Bone Marrow Aspiration Concentrate Injection for Knee Osteoarthritis: A Prospective Cohort Study of 68 Patients. Indian Journal of Orthopaedics. 2024 Nov 30:1-9. [Google Scholar]
4 Han JH, Jung M, Chung K, Jung SH, Choi CH, Kim SH. Bone Marrow Aspirate Concentrate Injections for the Treatment of Knee Osteoarthritis: A Systematic Review of Randomized Controlled Trials. Orthopaedic Journal of Sports Medicine. 2024 Dec 4;12(12):23259671241296555. [Google Scholar]