Hip Arthroscopy With Bone Marrow Aspirate Injection for Patients With Symptomatic Labral Tears and Early Degenerative Changes Shows Similar Improvement Compared With Patients Undergoing Hip Arthroscopy With Symptomatic Labral Tears Without Arthritis

Bone marrow aspirate concentrate adjunct for acetabular labral tear repair: a systematic review and meta-analysis

BACKGROUND

The objective of this study was to determine the effect of bone marrow aspirate concentrate (BMAC) on long-term patient outcomes when used as an adjuvant to acetabular repair of the labrum.

METHODS

A systematic review and meta-analysis were completed following PRISMA 2020 guidelines. Included in the analysis were controlled studies which assessed functional outcomes via the International Hip Outcome Tool-33 (iHOT-33) 12 or 24 months after acetabular repair with BMAC adjunct. Four studies totaling 315 participants were analysed.

RESULTS

Pooled effect sizes for iHOT-33 scores were not significantly different between control and treatment groups at 12 (p = 0.14, Cohen's D ≏ 0.79) or 24 months (p = 0.30, Cohen's D ≏ 0.56).

CONCLUSIONS

Non-significant trends in favor of BMAC augmentation were found in this study. However, the trends reported are promising and warrant further investigation with further randomised controlled trials.

Surgical Management of Hip Pain in Active Patients With Early Osteoarthritis: Navigating the Choice Between Hip Preservation and Arthroplasty

Hip pain in active patients with early osteoarthritis can be quite debilitating, affecting mobility, quality of life, and overall well-being. Management of this patient population is challenging because arthroplasty implants inevitably have limited life expectancy while chondral damage can mitigate the benefits of arthroscopic or open hip preservation. A multifaceted, patient-specific approach to clinical decision making is crucial in this patient population, given their higher activity level and expectations compared with older cohorts. Several advances have been made to better stratify patients into the spectrum of management, which includes nonsurgical measures; injections, including orthobiologics; arthroscopic hip preservation; open hip preservation; hip resurfacing; and total hip arthroplasty.

Post-operative injection of hydrolyzed collagen peptides shows anti-inflammatory effect in patients with femoroacetabular impingement improving the early recovery

Purpose

This study aimed to compare the use of cortisone (C), intra-articular injected at the end of hip arthroscopy in patients with femoroacetabular impingement (FAI), to a new Class III medical device based on hydrolyzed collagen peptides 'PEPTYS' (P) and, to investigate potential associations among preoperative symptoms and hip function, outcomes after arthroscopic surgery and presence of inflammatory biomarkers in synovial fluids (SFs) at basal condition.

Methods

The two treatments were administrated to patients scheduled for arthroscopy with simple blind randomization sampling. Based on the sample size calculation, the number necessary to recruit was at least 20 patients for the C group and 20 for the P group. SFs, when available, were obtained by aspiration just prior to surgical intervention. At the baseline, osteoarthritis (OA) severity was assessed with a radiographic scoring system (Tönnis classification). Physical examination and clinical assessment using the Hip disability and Osteoarthritis Outcome Score (HOOS) and visual analogue scale (VAS) score for pain were performed at the time of surgery and at 1 and 6 months of follow-up. At the time of surgery, chondral (Outerbridge score) and labral pathology based on direct arthroscopic visualization were also evaluated.

Results

Forty-seven FAI patients were enroled, with a median age of 35 years with a standard deviation (SD) of 10.6 and a body mass index of 24.3kg/m² with an SD of 4.5. 24 patients were treated with C and 23 with P. Both treatments did not show any statistically significant difference in hip function and pain. High expression of inflammatory molecules in SFs was correlated with the worst post-operative articular function.

Conclusions

Our study showed that the use of P was completely comparable to cortisone. Therefore, PEPTYS might be a valuable candidate to improve early recovery, in terms of pain and function, from arthroscopic FAI treatment.

Level of Evidence

Level III, comparative and randomized study.

Neither Bone Marrow Aspirate Concentrate nor Platelet-Rich Plasma Improves Patient-Reported Outcomes After Surgical Management of Acetabular Labral Tears; However, Bone Marrow Aspirate Concentrate May Be Effective for Moderate Cartilage Damage: A Systematic Review

Purpose

To (1) systematically assess which orthobiologic agents are being used in acetabular labral repairs and (2) report all available outcomes for patients undergoing operative management for labral repairs with orthobiologic agents.

Methods

The PubMed, Embase, and Cochrane databases were queried in August 2023. Articles were included if they used an orthobiologic agent during hip arthroscopy for acetabular labral repair and reported functional outcomes. Each study was queried for demographic data, orthobiologic agent used, volume of agent used, imaging modality used to guide administration, follow-up period, and all reported outcomes. The following Boolean phrase was used to systematically search the current literature: ((Orthobiologics) OR (Platelet-rich plasma) OR (PRP) OR (Mesenchymal stem cells) OR (MSCs) OR (Hyaluronic acid) OR (Growth factors) OR (bone marrow aspirate) OR (BMAC)) AND (hip joint OR (acetabular labrum) OR (Chondrolabr∗ damage) OR (Chondrolabr∗ tear)) AND (outcome∗ OR function∗ OR PROM OR PRO OR arthr∗ OR image OR pain OR complication).

Results

Three studies met the inclusion criteria and included 201 patients who received treatment with orthobiologic agents. Of these patients, 119 (59.7%) were women, with age ranging from 35 to 49 years. Ninety-seven patients (48.3%) received bone marrow aspirate concentrate (BMAC), and 104 (51.7%) received platelet-rich plasma (PRP). Both BMAC studies showed no significant improvements compared with controls; however, a subanalysis limited to patients with moderate cartilage damage who received BMAC showed significantly improved 2-year patient-reported outcome measures (International Hip Outcome Tool 33 score, 82.5 vs 69.5; P = .03). The one PRP study did not show significant improvements compared with controls. No complications were noted after either PRP or BMAC harvesting and application in any included study.

Conclusions

Overall, BMAC and PRP do not significantly improve patient-reported outcome measures compared with controls. However, there is limited evidence that BMAC may help patients with moderate cartilage damage.

Level of Evidence

Level III, systematic review of Level II and III studies.

Treatment of Hip Cartilage Defects in Athletes

Chondral defects in the athlete's hip are a relatively common occurrence, often presenting with debilitating pain and activity limitation. Preoperative identification of cartilage defects is challenging and there are many different modalities for treatment. Nonsurgical interventions, including activity modification, physical therapy, and injections, play a vital role, especially in less severe cases and as adjuncts to surgical intervention. Treating surgeons must be familiar with the cartilage restoration procedures available, including debridement, microfracture, and various implantation and transplantation options. Safe and effective management of cartilage defects is imperative to an athlete's return to sport. It is also imperative that surgeons are aware of all these various treatment options to determine what modality is best for their patients. This review serves to outline these options, cover the published literature, and provide general guidelines for surgeons when they encounter chondral defects in the office and the operating room.

The Second Annual Musculoskeletal Biologics Special Issue Highlights Evidence-Based Therapies

Orthopaedic biologics continues to hold great promise. The editors of Arthroscopy; Arthroscopy Techniques; and Arthroscopy, Sports Medicine, and Rehabilitation once again Call for Papers and invite authors to submit clinical musculoskeletal biologics original scientific research and technical notes with video. Our top articles are awarded inclusion in the Annual Musculoskeletal Biologics Special Issue.

Orthopaedic Musculoskeletal Biologics Research Impacts Patient Care: The Second Annual Arthroscopy Orthobiologics Virtual Special Issue

The field of orthobiologics is rapidly evolving, offering clinicians a shift in treatment from symptom relief to the potential for disease modification and tissue repair. These agents, derived from autologous tissues, components of blood, and growth factors, are used as surgical adjuncts or as standalone treatments. Their clinical applications are expanding to encompass a variety of conditions, supported by a growing base of research efforts. Arthroscopy and its companion publications are committed to evidence-based research with a robust history of publications that enhance clinical decision-making and impact patient care. This curated collection of articles highlights the year's most compelling advancements in orthopaedic musculoskeletal biologics research.

Bone Marrow Aspirate Concentrate Harvest Techniques for the Sports Medicine Surgeon

The use of bone marrow aspirate concentrate (BMAC) as a surgical augment to enhance biologic healing has been gaining popularity in a variety of sports medicine procedures. Due to its reliable availability from multiple sites, including the proximal tibia, proximal humerus, and anterior superior iliac spine, BMAC can be harvested at a location selected to be adjacent to the primary procedure. This Technical Note aims to highlight 3 different harvest sites for BMAC, allowing orthopaedic sports medicine surgeons to localize their harvest site based on the proximity of the planned procedure and ultimately increase efficiency.

Editorial Commentary: Hip Arthroscopy in Patients With Early Degeneration Who Receive Intra-Articular Bone Marrow Aspirate Concentrate Can Achieve Outcomes Similar to Nonarthritic Patients

The management of patients with early joint degeneration is challenging. In this setting, biologic interventions, from platelet-rich plasma to bone marrow aspirate concentrate (BMAC) to hyaluronic acid, may be beneficial. Recent research, with 2-year follow-up, shows that patients with early degenerative changes (Tönnis grade 1 or 2) who received intra-articular injection of BMAC after hip arthroscopy procedure had improvements in outcomes similar to nonarthritic patients (Tönnis 0) with symptomatic labral tears who underwent arthroscopy and did not receive BMAC. Although confirmatory investigation using patients with early degenerative changes as a control is required, it is possible that with BMAC, patients with early degenerative changes of their hip could achieve functional outcomes similar to patients with nonarthritic hips.