Bone marrow aspirate concentrate with cancellous allograft versus iliac crest bone graft in the treatment of long bone nonunions.

Abstract

Objectives:The purpose of this study was to compare bone marrow aspirate concentrate (BMAC) with cancellous allograft to iliac crest bone graft (ICBG) in the treatment of long bone nonunions.Design:Retrospective cohort study.Setting:A single level I trauma center.Patients:26 patients with long bone diaphyseal or metaphyseal nonunions with defects >2 mm and treated with open repair and BMAC, compared to 25 patients with long bone diaphyseal or metaphyseal nonunions with defects >2 mm and treated with open repair and ICBG.Intervention:Open repair of long bone nonunion using either autologous ICBG or BMAC with cancellous allograft.Main outcome measure:Nonunion healing, radiographically measured by the modified Radiographic Union Score for Tibia (mRUST) score. Secondary outcomes included risk factors associated with failed repair.Results:The union rates for the BMAC and ICBG cohorts were 75% and 78%, respectively (P = .8). Infection was the only risk factor of statistical significance for failure.Conclusion:In this study, we found no significant difference in union rate for long bone nonunions treated with ICBG or BMAC with allograft. BMAC and allograft led to 75% successful healing in this series. Given the heterogeneity of the control group and loss to follow-up, further prospective investigation should be conducted to more rigorously compare BMAC to ICBG for nonunion treatment.Level of evidence:III, retrospective cohort.