Abstract
We thank Drs Baria, McGee, Vasileff, and Durgam for their interest and comments regarding our study on the clinical efficacy of bone marrow aspirate concentrate (BMAC) and stromal vascular fraction (SVF) in patient with knee osteoarthritis (OA). 1 We agree that microfragmented adipose tissue (MFAT) and stromal vascular fraction (SVF) have distinct preparation methods and that it would be ideal to analyze them separately. However, there is a lack of research on the biological effect of these differences. Considering that, we elected to proceed with a broader approach by comparing the outcomes after an injection preparation from two different tissue sources, bone marrow and adipose tissue. 1 We think this is a reasonable step to lay the groundwork for more research in this rapidly evolving area.
It is important for clinicians to know whether the “newer” (compared with BMAC) adipose tissue–based therapies could potentially be established as treatment options for patients with knee OA, especially those who are not surgical candidates. Undoubtedly, there is a need for better education of clinicians on the different preparation methods of newer injection therapies and their impact on biological effect and patient outcomes given that the majority of currently practicing orthopaedic surgeons have not received formal training on these newer therapeutic modalities.
Drs Baria et al comment on the need to include the study by Shapiro et al 2 in our analysis and its potential to shift the conclusion. The study by Shapiro et al was not included in our analysis because patients in their study 2 presented with bilateral knee OA and received saline injection in the contralateral knee at the time of the BMAC injection, in addition to combining the BMAC with previously isolated platelet-poor plasma in their study. 2 We believed that this could complicate the analysis in our study. 1
Overall, we believe that our study provides the first step in accumulating data on the efficacy of a single injection of bone marrow–based versus adipose tissue–based treatment in patients with knee OA. As research evolves and data accumulate, future studies should focus on the analysis of aggregate data from studies using injection therapies with similar or identical preparation protocols and in patients with similar characteristics and similar profiles of knee pathology (including duration of knee pain, presence or absence of other symptoms, and radiographic grade of knee OA).
Footnotes
Submitted September 29, 2021; accepted October 5, 2021.
One or more of the authors has declared the following potential conflict of interest or source of funding: F.A.P. has received consulting fees from Zimmer Biomet, Stryker, Medical Device Business Services, Flexion Therapeutics, and Exactech; honoraria from Fidia Pharma and Musculoskeletal Transplant Foundation; and education support from Arthrex. J.R.L. has received consulting fees from DePuy Orthopaedics and Flexion Therapeutics, honoraria from Musculoskeletal Transplant Foundation, and royalties from DePuy Synthes Products. A.E.W. has received education support from Arthrex and Smith+Nephew, nonconsulting fees from Arthrex, and hospitality payments from Stryker. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.