Bone marrow aspirate concentrate (BMAC) is an autologous regenerative therapy enriched with mesenchymal stem cells (MSCs) and bioactive growth factors, offering potential disease-modifying effects in knee osteoarthritis (OA). Compared to conventional intra-articular treatments, including hyaluronic acid (HA), platelet-rich plasma (PRP), and corticosteroids, BMAC promotes cartilage regeneration, modulates inflammation, and enhances subchondral bone remodeling. Clinical evidence suggests that BMAC provides short- to mid-term symptomatic relief and functional improvement, with some studies indicating a potential to delay total knee arthroplasty (TKA). However, findings remain inconsistent, and long-term efficacy compared to PRP or autologous conditioned serum (ACS) is yet to be firmly established. Variability in BMAC preparation methods, injection protocols (single vs. repeated administration, intra-articular vs. subchondral delivery), and patient selection criteria complicates its clinical application, highlighting the need for standardized guidelines. Additionally, economic feasibility and cost-effectiveness concerns limit its widespread adoption. This review synthesizes current clinical evidence, evaluates optimal administration strategies, and explores future directions for improving treatment standardization and patient-specific therapy. Future research should prioritize well-designed, multicenter randomized controlled trials (RCTs) with long-term follow-up to confirm the sustained efficacy and therapeutic potential of BMAC in OA management.

Bone marrow aspirate concentrate (BMAC) is an autologous regenerative therapy enriched with mesenchymal stem cells (MSCs) and bioactive growth factors, offering potential disease-modifying effects in knee osteoarthritis (OA). Compared to conventional intra-articular treatments, including hyaluronic acid (HA), platelet-rich plasma (PRP), and corticosteroids, BMAC promotes cartilage regeneration, modulates inflammation, and enhances subchondral bone remodeling. Clinical evidence suggests that BMAC provides short- to mid-term symptomatic relief and functional improvement, with some studies indicating a potential to delay total knee arthroplasty (TKA). However, findings remain inconsistent, and long-term efficacy compared to PRP or autologous conditioned serum (ACS) is yet to be firmly established. Variability in BMAC preparation methods, injection protocols (single vs. repeated administration, intra-articular vs. subchondral delivery), and patient selection criteria complicates its clinical application, highlighting the need for standardized guidelines. Additionally, economic feasibility and cost-effectiveness concerns limit its widespread adoption. This review synthesizes current clinical evidence, evaluates optimal administration strategies, and explores future directions for improving treatment standardization and patient-specific therapy. Future research should prioritize well-designed, multicenter randomized controlled trials (RCTs) with long-term follow-up to confirm the sustained efficacy and therapeutic potential of BMAC in OA management.

Introduction: Sarcopenia, a loss of muscle mass and strength with aging, is associated with various TKA-related complications. In 2020, the AWGS published an undated guideline (AWGS 2019) based on studies from East and Southeast Asia. The purpose of this study was to determine the prevalence of sarcopenia in Asian female patients awaiting primary total knee arthroplasty due to advanced knee osteoarthritis using the updated AWGS criteria. Materials and Methods: The present study included 138 female patients who scheduled for primary TKA with severe osteoarthritis. The included patients were assessed with use of an AWGS 2019 diagnostic criteria based on muscle strength, physical performance, and appendicular skeletal muscle mass. Clinical parameters related to sarcopenia were collected and knee status assessed using the Knee Society scoring system. To better define the association with age, patients were stratified into following four groups: <60, 60–69, 70–79, ≥80. The prevalence of sarcopenia was identified, and the association between sarcopenia and clinical variables was analyzed. Results: The prevalence of sarcopenia and severe sarcopenia in this cohort according to the updated AWGS criteria was 35.5% and 21.7%. Prevalence of sarcopenia and severe sarcopenia significantly increased with advancing age ( p = .003, p = .040, respectively). Although not statistically significant, the proportion of severe sarcopenia among sarcopenia also increased with age. Multivariate logistic regression analysis revealed that lower BMI and lower 25-OH-vitamin D3 level were independent risk factors associated with sarcopenia in women awaiting TKA. Conclusions: In conclusion, our study confirmed that sarcopenia is more prominent amongst female patients awaiting primary TKA than the general population. Therefore, orthopedic surgeons should consider sarcopenia prevention and intervention in this group. Further studies are needed to investigate the effect of TKA on sarcopenia, and the difference of TKA outcomes between groups with or without underlying sarcopenia.

Background and objectives: Cartilage regeneration using mesenchymal stem cells (MSCs) has been attempted to improve articular cartilage regeneration in varus knee osteoarthritis (OA) patients undergoing high tibial osteotomy (HTO). Bone marrow aspirate concentrate (BMAC) and human umbilical cord blood-derived MSCs (hUCB-MSCs) have been reported to be effective. However, whether BMAC is superior to hUCB-MSCs remains unclear. This systematic review and meta-analysis aimed to determine the clinical efficacy of cartilage repair procedures with BMAC or hUCB-MSCs in patients undergoing HTO. Materials and Methods: A systematic search was conducted using three global databases, PubMed, EMBASE, and the Cochrane Library, for studies in which the clinical outcomes after BMAC or hUCB-MSCs were used in patients undergoing HTO for varus knee OA. Data extraction, quality control, and meta-analysis were performed. To compare the clinical efficacy of BMAC and hUCB-MSCs, reported clinical outcome assessments and second-look arthroscopic findings were analyzed using standardized mean differences (SMDs) with 95% confidence intervals (CIs). Results: The present review included seven studies of 499 patients who received either BMAC (BMAC group, n = 169) or hUCB-MSCs (hUCB-MSC group, n = 330). Improved clinical outcomes were found in both BMAC and hUCB-MSC groups; however, a significant difference was not observed between procedures (International Knee Documentation Committee score; p = 0.91, Western Ontario and McMaster Universities OA Index; p = 0.05, Knee Society Score (KSS) Pain; p = 0.85, KSS Function; p = 0.37). On second-look arthroscopy, the hUCB-MSC group showed better International Cartilage Repair Society Cartilage Repair Assessment grade compared with the BMAC group (p < 0.001). Conclusions: Both BMAC and hUCB-MSCs with HTO improved clinical outcomes in varus knee OA patients, and there was no difference in clinical outcomes between them. However, hUCB-MSCs were more effective in articular cartilage regeneration than BMAC augmentation.

Tibial tuberosity fractures are uncommon in adults. Surgery for these types of fractures is performed similarly to that of tibial tuberosity avulsion fractures in adolescents. The most commonly introduced method is to fix the displaced bone fragments using screws or wires and, if necessary, use tension band wiring for augmentation. However, if the bone fragments are too small or severely comminuted, it may be challenging to fix them using the conventional method. In this study, we introduced a fixation method using two knotless suture anchors that could be attempted in such cases. Since this surgical method fixes the bone fragments without direct damage to the bone fragments, it can be used even when the fragments are small or comminuted. This technique achieved a nearly full active range of knee motion without an extension lag at four weeks postoperatively. In addition, there were no complications related to surgery, and a complete bone union was achieved without additional dislocation. Therefore, this surgical method may be a good alternative if a fixation of the fracture is considered problematic by the conventional method. Cite this article as: Choi Y, Park D. A novel technique of tibial tuberosity fracture fixation with two knotless suture anchors in an adult: a case report and literature review. Acta Orthop Traumatol Turc., 2022;56(6):416-420.

Background and Objectives: With contemporary blood management strategies substantially reducing transfusion rates after total knee arthroplasty (TKA), conventional endpoints such as transfusion incidence and estimated blood loss may have limited sensitivity for evaluating adjunctive hemostatic interventions. As postoperative anemia evolves dynamically over time, hemoglobin kinetics and cumulative anemia burden may offer more informative measures of treatment effect. This study evaluated whether implementation of a topical thrombin–carboxymethyl starch hemostatic agent within a standardized modern blood management protocol was associated with smaller early postoperative hemoglobin decline and lower cumulative anemia burden after TKA. Materials and Methods: In this single-center, retrospective, pre–post observational study, consecutive patients aged 50 years or older undergoing primary unilateral TKA for osteoarthritis before and after implementation of a thrombin–carboxymethyl starch topical hemostatic agent were compared. Perioperative management was otherwise standardized and unchanged. Patients were matched 1:1 using propensity scores derived from eight prespecified covariates. Co-primary endpoints were hemoglobin change from baseline to postoperative day 1 and day 2, and cumulative anemia burden quantified by the area under the hemoglobin-deficit curve from POD 0 to POD 13 was assessed as a key secondary endpoint. Results: Of 564 patients assessed for eligibility, 328 met the inclusion criteria, and 70 propensity score-matched pairs were included in the final analysis. Unless otherwise specified, the outcomes reported below were analyzed in these 70 matched pairs. In the matched cohort, the intervention group had a lesser hemoglobin decrease at postoperative day (POD) 1 than the control group (2.12 ± 0.97 vs. 2.42 ± 0.98 g/dL), corresponding to a paired mean difference of 0.30 g/dL (95% CI, 0.08–0.52; p = 0.008). The between-group difference at POD 2 was not statistically significant (paired mean difference, 0.15 g/dL; 95% CI, −0.03 to 0.33; p = 0.10). The area under the hemoglobin-deficit curve from POD 0 to POD 13 was lower in the intervention group (18.6 ± 5.2 vs. 21.3 ± 5.6 g/dL × day), with a paired mean difference of 2.7 g/dL × day (95% CI, 0.9–4.5; p = 0.004). Estimated total blood loss, formula-derived hidden blood loss, and transfusion rates did not differ significantly between groups. Conclusions: Use of a thrombin–carboxymethyl starch topical hemostatic agent was associated with modest attenuation of early postoperative hemoglobin decline and lower cumulative anemia burden after TKA, without significant differences in estimated blood loss or transfusion occurrence. Hemoglobin kinetics and cumulative anemia burden may provide complementary outcome measures in contemporary low-transfusion practice, although these findings should be interpreted cautiously given the observational design and low transfusion event rate.