Editorial Commentary: Bone Marrow Aspirate Biologics for Osteochondral Allografts-Because We Can or Because We Should?

Orthobiologics are all the rage these days, and one of the hottest areas of study involves the use of autogenous bone marrow-derived biologics for preimplantation treatment of osteochondral allografts. Three recent Level III cohort studies based on shifts in practice have reported early imaging-based assessments of osteochondral allograft bone integration in the knee. Each study had unique, major limitations, and each reported disparate results. Based on this limited and contrasting available evidence, bone marrow aspirate-with or without concentration, for preimplantation treatment of osteochondral allografts-can be used based on safety, regulatory compliance, and basic science rationale. It does appear, however, to have the greatest clinical impact in "higher demand" cases in which allograft bone integration may be hampered based on patient factors, graft size and geometry, and/or implantation technique.