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A synthesis of the results was performed investigating disease\u2010modifying effects in preclinical animal studies comparing injectable bone marrow\u2010derived products with OA controls or other products, different formulations or injection intervals, and the combination with other products. The risk of bias was assessed according to the SYRCLE\u2019s tool.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Fifty\u2010three studies were included (1819 animals) with an increasing publication trend over time. Expanded cells were used in 48 studies, point\u2010of\u2010care products in 3 studies, and both approaches were investigated in 2 studies. Among the 47 studies presenting results on the disease\u2010modifying effects, 40 studies (85%) reported better results with bone marrow\u2010derived products compared to OA controls, with positive findings evident in 14 out of 20 studies (70%) in macroscopic assessment, in 30 out of 41 studies (73%) in histological assessment, and in 10 out of 13 studies (77%) in immunohistochemical evaluations. Clinical evaluations showed positive results in 7 studies out of 9 (78%), positive imaging results in 11 studies out of 17 (65%), and positive biomarker results in 5 studies out of 10 (50%). While 36 out of 46 studies (78%) reported positive results at the cartilage level, only 3 out of 10 studies (30%) could detect positive changes at the synovial level. The risk of bias was low in 42% of items, unclear in 50%, and high in 8%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This systematic review of preclinical studies demonstrated that intra\u2010articular injections of bone marrow\u2010derived products can induce disease\u2010modifying effects in the treatment of OA, slowing down the progression of cartilage damage with benefits at macroscopic, histological, and immunohistochemical levels. Positive results have been also observed in terms of clinical and imaging findings, as well as in the modulation of inflammatory and cartilage biomarkers, while poor effects have been described on the synovial membrane. These findings are important to understand the potential of bone marrow\u2010derived products and to guide further research to optimise their use in the clinical practice.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>II.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-023-07320-3","type":"journal-article","created":{"date-parts":[[2023,2,23]],"date-time":"2023-02-23T22:03:56Z","timestamp":1677189836000},"page":"3230-3242","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":41,"title":["Cell\u2010based therapies have disease\u2010modifying effects on osteoarthritis in animal models. A systematic review by the ESSKA Orthobiologic Initiative. 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