Biological augmentation of anterior cruciate ligament reconstruction with bone marrow aspirate concentrate: a systematic review and meta-analysis of randomised controlled trials

Purpose: Biological augmentation of anterior cruciate ligament (ACL) reconstruction with bone marrow aspirate concentrate (BMAC) is gaining attention for its theoretical potential to enhance postoperative healing and recovery. However, its clinical benefits remain uncertain, and its high cost raises questions about efficacy. Hence, we systematically reviewed randomised controlled trials (RCTs) to evaluate the effectiveness of BMAC in ACL reconstruction.

Methods: Our search included Cochrane, EMBASE, OVID, PubMed, and Scopus databases for RCTs evaluating the use of BMAC in ACL reconstruction. Primary outcomes focused on International Knee Documentation Committee (IKDC) scores and Lysholm scores. Secondary outcomes included MRI-related outcomes and postoperative complications. Statistical analysis was conducted using Review Manager 5.4 (Cochrane Collaboration), with heterogeneity assessed using Cochrane's Q test and I² statistics.

Results: 221 patients from five RCTs were included, with 109 (49.3%) receiving BMAC augmentation. Follow-up ranged from 11.05 to 24 months. No significant differences were found in postoperative IKDC scores between the BMAC and control groups at, three, six and 12 months. The BMAC group had significantly higher IKDC scores at 24 months; however, this difference was unlikely to be clinically significant. No significant differences were observed in postoperative Lysholm scores at 12 or 24 months. MRI-related outcomes suggested potential graft recovery improvement with BMAC, and complication rates were comparable between groups.

Conclusion: In summary, biological augmentation with BMAC in ACL reconstruction does not significantly improve early patient-reported outcomes but offers potential benefits in graft recovery without increasing complication rates.