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Cited by 99Periodontal Regeneration and TreatmentsOsteoarthritis Treatment and MechanismsTendon Structure and Treatment

Bone Marrow Aspirate Concentrate versus Platelet Rich Plasma or Hyaluronic Acid for the Treatment of Knee Osteoarthritis

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Dulic, Oliver, Rasovic, Predrag, Lalic, Ivica, Kecojevic, Vaso, Gavrilovic, Gordan, Abazovic, Dzihan, Maric, Dusan, Miskulin, Mladen, Bumbasirevic, Marko·2021·Medicina
DOI 10.3390/medicina57111193PMC PMC8623697
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Abstract

Background: In the last decade, regenerative therapies have become one of the leading disease modifying options for treatment of knee osteoarthritis (OA). Still, there is a lack of trials with a direct comparison of different biological treatments. Our aim was to directly compare clinical outcomes of knee injections of Bone Marrow Aspirate Concentrate (BMAC), Platelet-rich Plasma (PRP), or Hyaluronic acid (HA) in the OA treatment. Methods: Patients with knee pain and osteoarthritis KL grade II to IV were randomized to receive a BMAC, PRP, and HA injection in the knee. VAS, WOMAC, KOOS, and IKDC scores were used to establish baseline values at 1, 3, 6, 9, and 12 months. All side effects were reported. Results: A total of 175 patients with a knee osteoarthritis KL grade II-IV were randomized; 111 were treated with BMAC injection, 30 with HA injection, and 34 patients with PRP injection. There were no differences between these groups when considering KL grade, BMI, age, or gender. There were no serious side effects. The mean VAS scores after 3, 7, 14, and 21 days showed significant differences between groups with a drop of VAS in all groups but with a difference in the BMAC group in comparison to other groups (p < 0.001). There were high statistically significant differences between baseline scores and those after 12 months (p < 0.001) in WOMAC, KOOS, KOOS pain, and IKDC scores, and in addition, there were differences between these scores in the BMAC group in comparison with other groups, except for the PRP group in WOMAC and the partial IKDC score. There were no differences between the HA and PRP groups, although PRP showed a higher level of clinical improvement. Conclusions: Bone marrow aspirate concentrate, Leukocyte rich Platelet Rich Plasma, and Hyaluronic acid injections are safe therapeutic options for knee OA and provide positive clinical outcomes after 12 months in comparison with findings preceding the intervention. BMAC could be better in terms of clinical improvements in the treatment of knee OA than PRP and HA up to 12 months. PRP provides better outcomes than HA during the observation period, but these results are not statistically significant. More randomized controlled trials and high quality comparative studies are needed for direct correlative conclusions.

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  • Dulic et al. found that treatment with BMAC resulted in greater functional improvement as measured by WOMAC and KOOS compared to PRP and hyaluronic acid.

    “and functional improvement as measured by WOMAC and KOOS, compared to PRP and hyaluronic acid. [18]”

    From Management of platelet-rich plasma and stem cells versus conventional treatments in musculoskeletal injury repair: A systematic review (2025) · cites this paper as [18]

    The Results report better WOMAC scores for BMAC than for hyaluronic acid, but no statistically significant WOMAC difference between BMAC and PRP at any follow-up. KOOS pain scores favored BMAC over both comparators at some follow-ups, but the BMAC–PRP difference was not significant at 9 or 12 months. The claim omits these limits on the reported advantage. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • In patients with knee osteoarthritis, multiple studies reported significant reductions in pain, as measured by VAS, in groups treated with BMAC, MSCs, and PRP.

    “In patients with knee OA, multiple studies reported significant reductions in pain, as measured by the VAS scale, in groups treated with bone marrow aspirate concentrate (BMAC), MSCs, and PRP . [18]”

    From Management of platelet-rich plasma and stem cells versus conventional treatments in musculoskeletal injury repair: A systematic review (2025) · cites this paper as [18]

    The Results (page not available) report significant reductions in VAS pain from baseline in this study’s BMAC and PRP groups. The cited paper does not report a VAS pain-reduction result for a separate MSC-treated group, and its discussion of other studies does not establish the claimed VAS finding across multiple studies. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • In Dulic et al., KOOS scores were superior for BMAC compared to PRP, and PRP compared to HA.

    “Dulic et al., 2021 [18] | 175 with KL grade II- IV OA | BMAC | PRP, HA | VAS: greater reduction in BMAC days 3-21. KOOS: BMAC >PRP >HA. IKDC mostly superior.”

    From Management of platelet-rich plasma and stem cells versus conventional treatments in musculoskeletal injury repair: A systematic review (2025) · cites this paper as [18]

    The Results (§3; page unavailable) report higher KOOS pain scores for BMAC than PRP at several follow-ups, and the Discussion (§4; page unavailable) describes PRP as somewhat better than HA. But the Results find no statistically significant KOOS pain difference between PRP and HA at any measurement, or between BMAC and PRP at 9 and 12 months. The unqualified ranking overstates the evidence. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Dulic et al. found that treatment with BMAC resulted in greater short-term pain reduction (P < 0.001) compared to PRP and hyaluronic acid.

    “Dulic et al . found that treatment with BMAC resulted in greater short-term pain reduction ( P &lt; 0.001)”

    From Management of platelet-rich plasma and stem cells versus conventional treatments in musculoskeletal injury repair: A systematic review (2025) · cites this paper as [18]

  • In Dulic et al., IKDC was mostly superior for BMAC.

    “Dulic et al., 2021 [18] | 175 with KL grade II- IV OA | BMAC | PRP, HA | VAS: greater reduction in BMAC days 3-21. KOOS: BMAC >PRP >HA. IKDC mostly superior.”

    From Management of platelet-rich plasma and stem cells versus conventional treatments in musculoskeletal injury repair: A systematic review (2025) · cites this paper as [18]

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Cited by

Sorted by citations

Authors
Dulic, O., Rasovic, P., Lalic, I., Kecojevic, V., Gavrilovic, G., Abazovic, D., Maric, D., Miskulin, M., & Bumbasirevic, M.
Affiliations
  • Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia
  • Department for Orthopedic Surgery and Traumatology, Clinical Center of Vojvodina, Hajduk Veljkova 1-9, 21000 Novi Sad, Serbia
  • Atlas Hospital, 11000 Belgrade, Serbia
  • Renova Hospital Belgrade, 11000 Belgrade, Serbia
  • University of Novi Sad (RS)
  • Specijalna Bolnica za Neurokirurgiju i Ortopediju Aksis, 10000 Zagreb, Croatia
ORCID
Venue
Medicina
Publisher
MDPI AG
Published
2021-11-02
Volume
57
Issue
11
Pages
1193
ISSN
  • 1010-660X (ISSN-L)
  • 1648-9144
DOI
10.3390/medicina57111193
PMC
PMC8623697
OpenAlex
W3209017909
Cited by
99
References
0
Citations by year
2026: 15 · 2025: 27 · 2024: 30 · 2023: 12 · 2022: 15
FWCI
15.93
Type
journal article
Language
en
Open access
Licence
Locations
  • Medicina (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Provincial Government of Vojvodina, New technologies in Medicine (231-3/2016)
Topics
  • Health Sciences › Medicine › Urology › Periodontal Regeneration and Treatments
  • Health Sciences › Medicine › Rheumatology › Osteoarthritis Treatment and Mechanisms
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Tendon Structure and Treatment
Keywords
knee osteoarthritis, bone marrow aspirate concentrate, platelet-rich plasma, hyaluronic acid, intra-articular injection, regenerative therapy, knee pain, WOMAC, KOOS, IKDC score, treatment comparison, safety and side effects, knee function outcomes, knee swelling, knee instability, knee range of motion
MeSH terms
Bone Marrow, Humans, Hyaluronic Acid, Treatment Outcome, Osteoarthritis, Knee, Platelet-Rich Plasma

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