Adipose‐derived and bone marrow aspirate concentrate injections for osteoarthritis: A scoping review

BACKGROUND: Osteoarthritis is a leading cause of disability worldwide, and cell-based treatments including adipose-derived and bone marrow aspirate have been sought by the lay and medical community as treatment options. OBJECTIVE: To perform a scoping review of published literature on cell-based injections allowed by the U.S. Food and Drug Administration for the treatment of osteoarthritis to synthesize existing evidence and identify research gaps for future evaluation. METHODS: A comprehensive search of five databases was executed from inception through January 2, 2025. Studies that met the inclusion criteria were original research studies written in English on Food and Drug Administration-allowed cell-based treatments in adults with osteoarthritis of any joint. RESULTS: The database search yielded 4257 unique records. After screening, 84 studies met the inclusion criteria, encompassing 9996 patients and a total of 10,508 procedures. The primary research study designs were cohort studies (n = 62), focused on treatment of knee osteoarthritis (n = 63), and described bone marrow aspirate (n = 42) and adipose-derived (n = 42) treatments. Postprocedure monitoring ranged from 6 weeks to 5 years, with most studies ≤1 year (n = 59). Patient-reported outcomes were reported in 83 of 84 studies; few provided imaging outcomes including magnetic resonance imaging (n = 9) or radiographs (n = 2). CONCLUSION: This review identified limited randomized controlled trials, limited studies outside the knee, limited description of cell-based treatments, and treatment protocols, along with inconsistent patient-reported outcomes limited to 1 year in most studies. We propose establishing reporting guidelines in research on cell-based therapies.