Bone Marrow Aspirate Concentrate to Treat Ankle Osteoarthritis: A Narrative Review of Progress and Challenges

ObjectiveCurrently, there is a wide range of therapeutics that can be used to treat ankle osteoarthritis (OA), but none of them are able to fully restore the function of the ankle joint long-term. In this narrative review, we aim to summarize the current progress of using bone marrow aspirate concentrate (BMAC) for treating ankle OA.DesignPubMed was searched for publications that were published from 1990 until September 1, 2025 (moment of search). Key search terms were bone marrow aspirate concentrate and ankle OA. This yielded 17 hits, of which 10 were included in this narrative review.ResultsBMAC may enhance cartilage repair in ankle injuries and OA, especially when it is used in combination with other surgical techniques and biological treatments. However, the body of supporting evidence remains largely composed of Level II to IV studies (case-control and retrospective series). In addition, the independent role of BMAC remains unclear due to the lack of studies evaluating BMAC as a stand-alone treatment, as well as the unclear role that it plays as an adjuvant therapy.ConclusionsIn conclusion, the existing literature investigating BMAC for ankle OA is encouraging but remains inconclusive. High-quality randomized controlled trials with standardized protocols, longer follow-up, and head-to-head comparison against other treatment options are needed to establish both efficacy and cost-effectiveness. Establishing minimal reporting standards for BMAC composition is also critical to improve consistency across studies.