Ultrasound-Guided Posterior Iliac Crest Aspiration

Abstract

Background: Bone Marrow Aspirate (BMA) contains growth factors and signaling entities essential for local cellular repair. BMA and concentrated BMA injections (BMC) are used for orthopedic procedures, such as in treating cartilaginous and bony defects. Several techniques exist for harvesting BMA. A technique termed ultrasound-guided posterior iliac crest aspiration (UPICA) is of special interest. This case series wasundertaken to determine if practitioners can effectively perform the UPICA technique in a clinical setting. Methods: In accordance with the UPICA technique, ultrasound guidance was used to localize the posterior iliac crest. Following local anesthesia, aspiration was performed using 10 mL syringes at multiple depths. The periosteum was entered once. A needle was advanced 0.5 cm with each new depth. At each penetration level, 10 mL was drawn before rotating 90 degrees and aspirating an additional 10 mL. Following aspiration at various depths, approximately 60 mL of BMA was obtained. The inclusion criteria for this study were patients with diagnosed glenohumeral osteoarthritis, knee osteoarthritis, hip osteoarthritis, or rotator cuff tears whose condition had failed to improve with conservative care. The UPICA technique was performed in each case by the senior author (BG). Results: For the 10 cases, the average patient age was 72 (SD 7.6; range 58–81) years old. The sample included 8 males and 2 females. The mean total nucleated cell count (TNCC)/mL BMA was 9.7E+06 (SD 2.9E+06), while the TNCC/mL bone marrow concentrate (BMC) was 43.9E+06 (SD 29.5E+06), a 4.3 (SD 2.3)-fold increase in concentration. The mean cell colony forming units-fibroblasts (CFU-f)/mL BMA was 520 (SD 155) with a mean CFU-f/mL BMC of 4899 (SD 2887) resulting in a 9.6 (SD 4.6)-fold increase in concentration. The viability for the BMA was 97.5 (SD 2.3) %, and the BMC was 94.9 (SD 4.55) %. Conclusions: Utilizing the UPICA technique, similar yields for the BMC CFU-f/mL counts were obtained to those reported previously by other clinicians. Additionally, the results demonstrated the ability of the bone marrow concentration system to successfully concentrate the BMA. Based on these findings, the research team endorses the UPICA technique as a viable method for bone marrow aspiration.