A randomised controlled trial confirms the non‐superiority of bone marrow aspirate (BMA) from the posterior iliac crest and proximal tibia compared to platelet rich plasma (PRP) in the treatment of knee osteoarthritis
Bibliographic record
Abstract
Abstract Purpose The reported clinical trial aimed to determine the clinical efficacy of ex vivo mesenchymal stromal cells (MSCs) derived from bone marrow (BM), aspirated from the posterior iliac crest and proximal tibia, in comparison to autologous platelet‐rich plasma (PRP) for the knee osteoarthritis (KOA) treatment and to assess the differences in cellular yield between the two harvest sites. Methods A single‐centre, parallel, randomised controlled trial was designed to investigate the clinical effects of bone marrow aspirate (BMA) from the posterior iliac crest compared to BMA from the proximal tibia in treating KOA, with a control group receiving PRP. Ninety patients with KOA were divided equally among the three groups. Visual Analogue Score (VAS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) score were used for clinical outcome evaluation at 6 months after the treatment, and cellular analysis of BMA was performed. Results Cell count confirmed that the posterior iliac crest was significantly more densely populated with mononuclear cells than the proximal tibia. Flow cytometric analysis of ex vivo BMA also confirmed a significantly greater number of MSCs in the BM‐derived from the posterior iliac crest when compared with the proximal tibia, together with a significantly higher number of platelets. The analysis confirmed that the improvement in early pain and function scores after each treatment was statistically significant within each of the three groups (median VAS decrease: PRP Group −2 ( p < 0.001), Crest Group −2 ( p < 0.001), Tibia Group −2 ( p < 0.001)), (median WOMAC decrease: PRP Group −13.5 ( p < 0.001), Crest Group −12.5 ( p < 0.001), Tibia Group −12 ( p < 0.001)). However, no statistically significant differences were observed in the improvements among the three study groups. A significantly greater improvement in VAS was observed in patients with Kellgren Lawrence (KL) I–II. In the Tibia Group, the effect of BMA on the change in VAS was associated with BMI and %MSCs, whereas in the Crest Group, the change in WOMAC score was associated with %BM and platelet count. Conclusion The iliac crest yields a higher concentration of MSCs compared to the proximal tibia. However, both sources demonstrated a beneficial clinical outcome in the treatment of KOA, with no evidence of superiority over PRP treatment. Level of Evidence Level I.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.008 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.006 | 0.003 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.003 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.009 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".