Bone Marrow Aspirate Augmentation Reduces Reoperation Rates After Osteochondral Allograft Transplantation of the Knee: A Systematic Review

Why clinicians should know about it

• Picked for Orthopedics and Sports Medicine (paper of the day, 21 September 2026): BMA augmentation reduces reoperation after osteochondral allograft knee transplant

Abstract

PURPOSE: To systematically review the clinical, radiographic, and patient-reported outcomes of osteochondral allograft (OCA) transplantation with versus without bone marrow aspirate (BMA) augmentation for the treatment of knee cartilage defects. METHODS: A comprehensive search was performed according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Comparative clinical studies assessing OCA with and without BMA were included. Two reviewers independently performed screening, data extraction, and methodological quality assessment using the Cochrane Risk of Bias Tool 2.0 for randomized trials and the Methodological Index for Non-Randomized Studies for nonrandomized studies. RESULTS: Four studies (3 Level III, 1 Level I) involving 165 knees met the inclusion criteria. The mean follow-up duration across studies ranged from 5.5 to 18.0 months. Across 2 comparative studies, BMA augmentation was associated with fewer reoperations (2.4% vs 21.9%) compared with non-BMA augmentation. Radiographic findings were heterogeneous: 1 study showed earlier integration and reduced sclerosis with BMA at 6 months, whereas 2 magnetic resonance imaging-based studies showed no differences in OCA Magnetic Resonance Imaging Scoring System scores. Computed tomography assessment in 1 trial found increased small cysts but a trend toward fewer large cysts in BMA-treated grafts. Patient-reported outcomes from 1 study showed no significant differences in International Knee Documentation Committee or Knee injury and Osteoarthritis Outcome Score for Joint Replacement scores between groups, although achievement of the Knee injury and Osteoarthritis Outcome Score for Joint Replacement minimal clinically important difference favored the BMA cohort (88% vs 55%; P = .076). CONCLUSIONS: OCA transplantation augmented with BMA is associated with significantly lower reoperation rates compared with nonaugmented transplantation. Although short-term radiographic data show improved early subchondral remodeling, these findings are not consistently corroborated by magnetic resonance imaging-based scores. LEVEL OF EVIDENCE: Level III, systematic review of Level I and III studies.

Abstract as published, via PubMed.