Autologous Bone Marrow Aspirate Research Articles

Arthroscopic Treatment of Osteochondral Lesions of the Talus Using Juvenile Articular Cartilage Allograft and Autologous Bone Marrow Aspirate Concentration

Juvenile allogenic chondrocyte implantation (JACI; DeNovo NT Natural Tissue Graft®; Zimmer, Warsaw, IN) with autologous bone marrow aspirate concentrate (BMAC) is a relatively new all-arthroscopic procedure for treating critical-size osteochondral lesions (OCLs) of the talus. Few studies have investigated the clinical and radiographic outcomes of this procedure. We collected the clinical and radiographic outcomes of patients who had undergone JACI-BMAC for talar OCLs to assess treatment efficacy and cartilage repair tissue quality using magnetic resonance imaging (MRI). Forty-six patients with critical-size OCLs (≥6 mm widest diameter) received JACI-BMAC from 2012 to 2014. We performed a retrospective medical record review and assessed the functional outcomes pre- and postoperatively using the Foot and Ankle Outcome Score (FAOS) and Short-Form 12-item general health questionnaire. MRI was performed preoperatively and at 12 and 24 months postoperatively. Cartilage morphology was evaluated on postoperative MRI scans using the magnetic resonance observation of cartilage tissue (MOCART) score. The pre- to postoperative changes and relationships between outcomes and lesion size, bone grafting, lesion location, instability, hypertrophy, and MOCART scores were analyzed. Overall, the mean questionnaire scores improved significantly, with almost every FAOS subscale showing significant improvement postoperatively. Concurrent instability resulted in more changes that were statistically significant. The use of bone grafting and the presence of hypertrophy did not result in statistically significant changes in the outcomes. Factors associated with outcomes were lesion size and hypertrophy. Increasing lesion size was associated with decreased FAOS quality of life subscale and hypertrophy correlating with changes in the pain subscale. Of the 46 patients, 22 had undergone postoperative MRI scans that were scored. The average MOCART score was 46.8. Most patients demonstrated a persistent bone marrow edema pattern and hypertrophy of the reparative cartilage. Juvenile articular cartilage implantation of the DeNovo NT allograft and BMAC resulted in improved functional outcome scores; however, the reparative tissue still exhibited fibrocartilage composition radiographically. Further studies are needed to investigate the long-term outcomes and determine the superiority of the arthroscopic DeNovo procedure compared with microfracture and other cartilage resurfacing procedures.

Evaluation of single and multiple use of bone marrow aspirate in management of tibia fractures of Nigerian indigenous dogs

ABSTRACTOsteogenic potential of autologous bone marrow aspirates was evaluated on transverse tibia fractures of 12 Nigeria indigenous dogs presented to University of Nigeria Veterinary Teaching Hospital, Nsukka (UNVTH). They were assigned into four groups: single application group (Group1; n = 3), double application group (Group 2; n = 3), triple application group (Group 2; n = 3) and the control group (Group 3; n = 3). The fractures were immobilized with Steinmann intramedullary pins in a normograde manner. The patients were then treated as follows: Group 1: with autologous bone marrow aspirate on the day of surgery; Group 2: with autologous bone marrow aspirate on days 0 and 14 post surgery; Group 3: with autologous bone marrow aspirate on days 0, 14 and 28 post surgery; Group 4: 1 ml normal saline was applied on the fracture site. Post-treatment radiographs of the fractures were taken on weeks 1, 2, 4, 7 and 10. The rate of healing was compared using radiographic union scale for tibia scores. The results showed a significant difference (p < .05) in the healing of the treated groups and the control at week 7 post surgery. There was however no significant (p > .05) difference in the healing of the fractures with single and the multiple applications.

Inefficacy of autologous bone marrow concentrate in stage three osteonecrosis: a randomized controlled double-blind trial.

The fracture stage of non-traumatic osteonecrosis (ON stage 3) of the femoral head (ONFH) has an unfavourable prognosis frequently requiring total hip replacement (THR). The percentage could be lowered after core decompression. In earlier non-fracture ON stages, implantation of autologous bone marrow aspirate concentrate (BMAC) improved the effect of core decompression. The purpose was to evaluate the effect of BMAC in addition to core decompression in stage 3 ONFH. A double blind RCT was conducted comparing two groups: core decompression plus saline injection or core decompression plus BMAC implantation. Both patients and assessors were blinded to the treatment assignments. Evaluations were done at baseline, three, six, 12, and 24months, including pain (VAS), WOMAC, side-effects, radiological evolution including ARCO subclassifications, together with possible THR requirement. The primary endpoint was the need for THR. The second endpoints included the clinical symptoms such as pain and functional ability and the progression of the ON lesions as well as the appearance of osteoarthritis features (ARCO stage 4). Both groups included 23 hips (19 patients). No differences were found between the groups for THR requirements, clinical tests, and radiological evolution. In both groups, 15/23 hips needed THR. The radiological evolution of the ONFH lesions in term of location, extension, surface collapse, and dome depression was moderate in both groups and was not correlated with the need of THR. Implantation of BMAC after core decompression did not produce any improvement of the evolution of ONFH stage 3. Level of evidence I.

Outcome of Autologous Bone Marrow Aspirate Concentrate (BMAC) Transplantation in Patient with Spinal Cord Injury: Our experiences

Outcome of Autologous Bone Marrow Aspirate Concentrate (BMAC) Transplantation in Patient with Spinal Cord Injury: Our experiences

Hip preserving surgery with concentrated autologous bone marrow aspirate transplantation for the treatment of asymptomatic osteonecrosis of the femoral head: retrospective review of clinical and radiological outcomes at 6\xa0years postoperatively

BackgroundWe had previously established concentrated autologous bone marrow aspirate transplantation (CABMAT), a one-step, low-invasive, joint-preserving surgical technique for treating osteonecrosis of the femoral head (ONFH). The present study aimed to evaluate the effects of CABMAT as a hip preserving surgical approach, preventing femoral head collapse in asymptomatic ONFH.MethodsIn total, 222 patients (341 hips) with ONFH were treated with CABMAT between April 2003 and March 2013. Based on magnetic resonance imaging, we determined that 119 of these patients had bilateral asymptomatic ONFH (238 hips), and 38 further patients had unilateral asymptomatic ONFH (38 hips). In this series, we retrospectively examined 31 hips in 31 patients with unilateral asymptomatic ONFH treated surgically between 2003 and 2012 and followed up for more than 2 years. Clinical and radiological evaluation were performed immediately before the procedure and at the final follow-up. The two-year follow-up rate among patients with unilateral ONFH was 82% (31/38). Therefore, the present study included 31 patients (19 males and 12 females), with a mean age and follow-up period of 40 and 5.8 years, respectively. Of the 31 asymptomatic hips, 5, 6, 10, and 10 had osteonecrosis of types A, B, C1, and C2, respectively. The diagnosis, classification, and staging of ONFH were based on the 2001 Japanese Orthopaedic Association (JOA) classification.ResultsSecondary collapse of the femoral head was observed in 6/10 hips and 5/10 hips with osteonecrosis of types C1 and C2, respectively. Total hip arthroplasty was performed in 9.6% of patients (3/31 hips), at an average of 33 months after surgery. Clinical symptoms improved after surgery, and the secondary collapse rate at a mean of 5.8 years after CABMAT was lower than that reported in several previous studies on the natural course of asymptomatic ONFH.ConclusionsEarly diagnosis of ONFH (i.e., before femoral head collapse) and early intervention with CABMAT could improve the clinical outcome of corticosteroid and alcohol-induced ONFH.

Repair of segmental radial defect with autologous bone marrow aspirate and hydroxyapatite in rabbit radius: A clinical and radiographic evaluation.

Aim:Finding an ideal bone substitute to treat large bone defects, delayed union and nonunions remain a challenge for orthopedic surgeons and researchers. Several studies have been conducted on bone regeneration; each has its own advantages and disadvantages. The aim of this study was to evaluate the effect of a combination of hydroxyapatite (HA) powder with autologous bone marrow (BM) aspirate on the repair of segmental radial defect in a rabbit model.Materials and Methods:A total of 36 male and adult New Zealand rabbit with a mean weight of 2.25 kg were used in this study. Approximately, 5 mm defect was created in the mid-shaft of the radius to be filled with HA powder in the control group “HA” (n=18) and with a combination of HA powder and autologous BM aspirate in the test group “HA+BM” (n=18). Animals were observed daily for healing by inspection of the surgical site, and six rabbits of each group were sacrificed at 30, 60, and 90 post-operative days to perform a radiographic evaluation of defect site.Results:Obtained results revealed a better and more rapid bone regeneration in the test group: Since the defect was rapidly and completely filled with mature bone tissue after 90 days.Conclusion:Based on these findings, we could infer that adding a BM aspirate to HA is responsible of a better regeneration process leading to a complete filling of the defect.

Autologous Bone Marrow Aspirate Therapy for Skin Tissue Engineering and Tissue Regeneration.

Introduction: Chronic wounds that are difficult to heal are physical and financial burden to the sufferer and a challenge to the treating physician. Objective: The main purpose of this study was to develop a novel method of using bone marrow (BM) aspirate, either cultured or fresh, as early solution for healing of chronic wounds and further reduce infection and tissue necrosis. Approach: In this case-control study conducted on 75 patients with chronic wounds, 50 patients with aspirate or cultured BM were used as cases and 25 with only daily saline dressings were used as controls. Results: Autologous BM aspirate either as fresh or cultured even without identification, isolation, and selective application of stem cells achieved significant reduction in the wound surface area when compared with control group. Innovation: The application of cultured BM cells had significantly higher percentage reduction of wound size compared to freshly applied BM aspirate; this reflects a high importance of stem cell therapy. Conclusion: The acceptability of the procedure among the patients was highly encouraging. The entire procedure was safe and without any complication.

Predicting Risk Factors of Total Hip Arthroplasty Conversion after Concentrated Autologous Bone Marrow Aspirate Transplantation for the Treatment of Idiopathic Osteonecrosis of the Femoral Head: A Retrospective Review of 213 Hips at a Mean Follow-up of 5 Years

To identify the predictive risk factors of total hip arthroplasty (THA) conversion after concentrated autologous bone marrow aspirate transplantation (CABMAT) as a hip joint–preserving surgery for idiopathic osteonecrosis of the femoral head (ONFH). We retrospectively reviewed 123 patients (213 hips; 65 men [115 hips]) who underwent CABMAT (average age: 40 years) between April 2003 and December 2010. The mean follow-up period was 61 months. Of 213 hips, 144 had corticosteroid-associated ONFH, 46 had alcohol-associated ONFH, and 23 had no identifiable etiological factors. We investigated age; sex; body mass index (BMI); history of using bisphosphonates, steroids, and proton pump inhibitors; etiologic factors; preoperative disease classification and staging; Japanese Orthopedic Association clinical score; and various clinical data. Multivariate logistic regression analysis was performed to analyze the data. Of 213 hips, 51 (23.9%) were converted to THA. The conversion rates were 18.6% in the precollapse group (stages 1 and 2) and 30.0% in the postcollapse group (stages 3–4). The conversion rate to THA was 0% in patients with the preoperative disease types A and B. Moreover, treatment in 62.5% of patients in stage 4 was converted to THA. In multivariate logistic regression analysis, the disease type, BMI, history of bisphosphonates use, hospitalization duration, and age were significantly correlated with conversion to THA. The largest THA conversion predictive factor was the type C2. The preoperative disease type, BMI, and history of bisphosphonates use can predict conversion to THA and suggest which patients with idiopathic ONFH are appropriate for CABMAT treatment. Our new marrow concentration method for CABMAT improves the reliability of hip preserving surgery, and further research is warranted.

Feasibility and Efficacy of Autologous Bone Marrow Aspirate Transplantation Combined with Human Parathyroid Hormone 1-34 Administration to Treat Osteonecrosis in a Rabbit Model

No studies have examined the transplantation of a bone marrow aspirate (BMA) containing mesenchymal stem cells (MSCs) combined with human parathyroid hormone 1-34 (hPTH1-34) administration. Therefore, we evaluated the feasibility and efficacy of autologous BMA transplantation combined with hPHT1-34 administration in a bone necrosis model. The metatarsal bones of rabbits were necrotized using liquid nitrogen, and the rabbits received a BMA transplantation or saline injection followed by hPTH1-34 (30 μg/kg) or saline administration three times per week (n = 3-4 per group). The rabbits were euthanized at 12 weeks after the initiation of treatment. No systemic adverse effects or local neoplastic lesions were observed. Importantly, the rabbits in the BMA transplantation plus hPTH1-34 group showed the highest bone volumes and histological scores of new bone. These data confirmed the feasibility of BMA transplantation combined with hPTH1-34, at least during the experimental period. The observed efficacy may be explained by a synergistic effect from the stimulation of MSC differentiation to osteoblasts with hPTH1-34-mediated suppression of apoptosis in osteoblasts. These results indicate the promising potential for BMA transplantation combined with hPTH1-34 administration in bone necrosis treatment. Longer term experiments are needed to confirm the safety of this therapeutic strategy.

The Influence of Aspiration Volume on the Number of Osteoblastic Progenitors Obtained From Bone Marrow in Children.

Autologous bone marrow aspirates are utilized to treat various conditions in children. The biological value of bone marrow aspirate depends on the concentration of competent osteoblastic progenitors present in the aspirate. It has been shown in adults that increasing bone marrow aspiration volume beyond 2 mL decreases the concentration of osteoblast progenitor cells because of dilution of the sample with peripheral blood. The effect of varying bone marrow aspiration volumes on the osteoblast cell content has not been determined in children. In total, 21 children (3 male and 18 female patients, age range 8 mo to 14 y) scheduled for pelvic osteotomy were included in the study. Three separate bone marrow aspirates of 1, 5, and 10 mL were obtained from the anterior superior iliac crest. Total number of nucleated cells was counted per aspirate and the prevalence of alkaline phosphatase-positive colony-forming units was determined per million nucleated cells. We measured a significant, proportional increase in the total number of nucleated bone marrow precursor cells between the 1 and 5 mL samples (mean±SD, 27±13 and 152±78 million nucleated cells, respectively; P<0.0001). When the aspiration volume doubled from 5 to 10 mL the total number of nucleated cells was 178±76 million (P=0.17). A proportional increase from 2214 alkaline phosphatase-positive colony-forming units in the 1 mL sample to 14,100 alkaline phosphatase-positive colony-forming units in the 5 mL sample was observed. However, the number of colony-forming units per aspirate decreased to 11,880 in the 10 mL sample. These data demonstrate that in children aspiration up to 5 mL bone marrow from the iliac crest yields a proportional increase in osteoblastic progenitor cells per aspirate. Increasing the aspiration volume beyond 5 mL results in hemodilution, rather than further selection of osteoblastic material. These data provide clinicians with a guideline for optimizing aspiration volume of bone marrow in children. Level II-development of diagnostic criteria on basis of consecutive patients.

Role of prophylactic autologous bone marrow aspirate injection in accelerating union and rehabilitation in long bone fractures in surgically unfit patients

Background: Autologus Bone grafting is a commonly performed second surgery in non-union of operated long bones fractures. In some patients surgery is not possible because of anaesthetic complications and other co-mobid conditions, a simple plaster immobilisation may not be sufficient. a simple bone marrow aspiration and fracture site injection would be an alternate to bone graft in these patients. Materials and Methods: This Study included 50 patients divided into two groups A and B, 25 in each group, having fractures of long bones except femur managed with closed reduction and cast application. 13 patients of group A and 14 of B had poor prognosis for union. Group A were treated with immobilisation alone and Group B treated with Immobilisation and Bone marrow aspirate injection. Results: 30.77% patients of poor prognosis attained union at 6 months without Bone marrow aspirate injections(Group A) and 92.86% patients attained union with Bone marrow aspirate injections (Group B). Patients in Group A on an average took 10.3 months to perform full weight bearing whereas Patients in Group B took 6.8 months. Discussion: Bone marrow aspirate injection definitely increase the union rates and decrease the period of immobilisation in long bone fractures. It can be a blessing in patients with medical limitation to surgery.Conclusion: Bone marrow aspirate injection definitely increase the union rates and decrease the period of immobilisation in long bone fractures managed conservatively It can be a blessing in patients with medical limitation to surgery.

Magnetic Resonance Imaging (MRI) of a Hypertrophy of Cartilage and Simultaneous Regeneration of a Damaged Meniscus after Autologous Bone Marrow Aspirates Concentrate (BMAC) Transplantation: a Case Report and Literature Review

Magnetic Resonance Imaging (MRI) of a Hypertrophy of Cartilage and Simultaneous Regeneration of a Damaged Meniscus after Autologous Bone Marrow Aspirates Concentrate (BMAC) Transplantation: a Case Report and Literature Review

Partial Cranial Cruciate Ligament Tears Treated with Stem Cell and Platelet-Rich Plasma Combination Therapy in 36 Dogs: A Retrospective Study.

To evaluate outcomes in 36 dogs with a partial cranial cruciate ligament (CCL) tear treated with autologous bone marrow aspirate concentrate (BMAC) or adipose-derived progenitor cells (ADPC) with platelet-rich plasma (PRP) combination. Medical records of client-owned dogs diagnosed with an early partial (≤50%) tear of the craniomedial band of the CCL that was treated with BMAC-PRP or ADPC-PRP were reviewed from 2010 to 2015. Signalment, medical history, physical and orthopedic examination, objective temporospatial gait analyses, radiographs, day 0 and day 90 diagnostic arthroscopy findings, treatment, and outcome were among the data collected. A functional owner questionnaire, including the validated Helsinki chronic pain index (HCPI), was sent to owners whose dog was known to not have had a tibial plateau leveling osteotomy (TPLO). Statistical analysis was performed on data, where significance was established at p < 0.05. Stifle arthroscopy findings at 90 days posttreatment were available on 13 of the 36 dogs. In nine dogs, a fully intact CCL with marked neovascularization and a normal fiber pattern was found with all previous regions of disruption healed. One dog revealed significant improvement and received an additional injection. The remaining three dogs had a >50% CCL tear, and a TPLO was performed. Four additional dogs were known to have had a TPLO performed elsewhere. Baseline and day 90 posttreatment objective gait analyses were available on 11 of the 36 dogs. A significant difference was found between the treated limb total pressure index percent (TPI%) at day 0 and day 90 (p = 0.0124), and between the treated limb and contralateral limb TPI% at day 0 (p = 0.0003). No significant difference was found between the treated limb and contralateral limb TPI% at day 90 (p = 0.7466). Twelve questionnaires were returned, of which eight were performance/sporting dogs. Seven of the eight had returned to sport; the remaining dog had just begun a return to sport conditioning program 6 months posttreatment. All 12 respondents believed that their dog had an excellent or very good quality of life and rated their dog's procedural outcome as excellent or good. The use of BMAC-PRP and ADPC-PRP shows promise for the treatment of early partial CCL tears in dogs. Further studies are needed and should be randomized, blinded, and controlled.

Bone Marrow Aspirate Concentrate in Combination With Intravenous Iloprost Increases Bone Healing in Patients With Avascular Necrosis of the Femoral Head: A Matched Pair Analysis.

With disease progression, avascular necrosis (AVN) of the femoral head may lead to a collapse of the articular surface. The exact pathophysiology of AVN remains unclear, although several conditions are known that can result in spontaneous cell death, leading to a reduction of trabecular bone and the development of AVN. Hip AVN treatment is stage-dependent in which two main stages of the disease can be distinguished: pre-collapse (ARCO 0-II) and post-collapse stage (ARCO III-IV, crescent sign). In the pre-collapse phase, core decompression (CD), with or without the addition of bone marrow (e.g. bone marrow aspirate concentrate, BMAC) or bone graft, is a common treatment alternative. In the post-collapse phase, THA (total hip arthroplasty) must be performed in most of the patients. In addition to surgical treatment, the intravenous application of Iloprost has been shown to have a curative potential and analgesic effect. From October 2009 to October 2014, 49 patients with AVN (stages I-III) were treated with core decompression at our institution. All patients were divided into group A (CD + BMAC) and group B (CD alone). Of these patients, 20 were included in a matched pair analysis. The patients were matched to age, gender, ARCO-stage, Kerboul combined necrotic angle, the cause of AVN, and whether Iloprost-therapy was performed. The Merle d’Aubigné Score and the Kerboul combined necrotic angle in a-p and lateral radiographs were evaluated pre- and postoperatively. The primary endpoint was a total hip arthroplasty. In group A, two patients needed THA while in group B four patients were treated with THA. In group A, the Merle d’Aubigné Score improved from 13.5 (pre-operatively) to 15.3 (postoperatively). In group B there was no difference between the pre- (14.3) and postoperative (14.1) assessment. The mean of the Kerboul angle showed no difference in both groups compared pre- to postoperatively (group A: pre-op 212°, postop 220°, group B: pre-op 213, postop 222°). Regarding radiographic evaluation, the interobserver variability revealed a moderate agreement between two raters regarding the pre-(ICC 0.594) and postoperative analysis (ICC 0.604).This study demonstrates that CD in combination with the application of autologous bone marrow aspirate concentrate into the femoral head seems to be a safe and efficient treatment alternative in the early stages of AVN of the femoral head when compared to CD alone.

Flow-Induced Axial Vascularization: The Arteriovenous Loop in Angiogenesis and Tissue Engineering.

Fabrication of a viable vascular network providing oxygen supply is identified as one crucial limiting factor to generate more complex three-dimensional constructs. The arteriovenous loop model provides initial blood supply and has a high angioinductive potency, making it suitable for vascularization of larger, tissue-engineered constructs. Also because of its angiogenic capabilities the arteriovenous loop is recently also used as a model to evaluate angiogenesis in vivo. This review summarizes the history of the arteriovenous loop model in research and its technical and surgical aspects. Through modifications of the isolation chamber and its containing matrices, tissue generation can be enhanced. In addition, matrices can be used as release systems for local application of growth factors, such as vascular endothelial growth factor and basic fibroblast growth factor, to affect vascular network formation. A special focus in this review is set on the assessment of angiogenesis in the arteriovenous loop model. This model provides good conditions for assessment of angiogenesis with the initial cell-free environment of the isolation chamber, which is vascularized by the arteriovenous loop. Because of the angiogenic capabilities of the arteriovenous loop model, different attempts were performed to create functional tissue in the isolation chamber for potential clinical application. Arteriovenous loops in combination with autologous bone marrow aspirate were already used to reconstruct large bone defects in humans.

Identification and validation of multiple cell surface markers of clinical-grade adipose-derived mesenchymal stromal cells as novel release criteria for good manufacturing practice-compliant production.

BackgroundClinical translation of mesenchymal stromal cells (MSCs) necessitates basic characterization of the cell product since variability in biological source and processing of MSCs may impact therapeutic outcomes. Although expression of classical cell surface markers (e.g., CD90, CD73, CD105, and CD44) is used to define MSCs, identification of functionally relevant cell surface markers would provide more robust release criteria and options for quality control. In addition, cell surface expression may distinguish between MSCs from different sources, including bone marrow-derived MSCs and clinical-grade adipose-derived MSCs (AMSCs) grown in human platelet lysate (hPL).MethodsIn this work we utilized quantitative PCR, flow cytometry, and RNA-sequencing to characterize AMSCs grown in hPL and validated non-classical markers in 15 clinical-grade donors.ResultsWe characterized the surface marker transcriptome of AMSCs, validated the expression of classical markers, and identified nine non-classical markers (i.e., CD36, CD163, CD271, CD200, CD273, CD274, CD146, CD248, and CD140B) that may potentially discriminate AMSCs from other cell types. More importantly, these markers exhibit variability in cell surface expression among different cell isolates from a diverse cohort of donors, including freshly prepared, previously frozen, or proliferative state AMSCs and may be informative when manufacturing cells.ConclusionsOur study establishes that clinical-grade AMSCs expanded in hPL represent a homogeneous cell culture population according to classical markers,. Additionally, we validated new biomarkers for further AMSC characterization that may provide novel information guiding the development of new release criteria.Clinical trialsUse of Autologous Bone Marrow Aspirate Concentrate in Painful Knee Osteoarthritis (BMAC): Clinicaltrials.gov NCT01931007. Registered August 26, 2013.MSC for Occlusive Disease of the Kidney: Clinicaltrials.gov NCT01840540. Registered April 23, 2013.Mesenchymal Stem Cell Therapy in Multiple System Atrophy: Clinicaltrials.gov NCT02315027. Registered October 31, 2014.Efficacy and Safety of Adult Human Mesenchymal Stem Cells to Treat Steroid Refractory Acute Graft Versus Host Disease. Clinicaltrials.gov NCT00366145. Registered August 17, 2006.A Dose-escalation Safety Trial for Intrathecal Autologous Mesenchymal Stem Cell Therapy in Amyotrophic Lateral Sclerosis. Clinicaltrials.gov NCT01609283. Registered May 18, 2012.Electronic supplementary materialThe online version of this article (doi:10.1186/s13287-016-0370-8) contains supplementary material, which is available to authorized users.

Ream content a stem cell source for bone defects

Bone grafts are normally used for the treatment of bone defects and non-union fractures, and the most common donor site is the iliac crest. The reamer-irrigator-aspirator (RIA) is an innovative technology to obtain osseous particles during intramedullary reaming in femur fractures. Discarded RIA can provide abundant native bone marrow mesenchymal stem cells (BM-MSCs) compared to the iliac crest. Autograft obtained from the use of RIA shows osteogenic potential at least equal to the iliac crest autograft with less donor site morbidity. The disadvantages of using the iliac crest including small volume, invasive harvesting, pain for the patient, makes RIA-harvested autograft bone preferable because it has good properties and is amenable for use as a sole alternative to the iliac crest graft or as a graft expander in conjunction with autologous iliac crest bone marrow aspirate.

Comparison of Juvenile Allogenous Articular Cartilage and Bone Marrow Aspirate Concentrate versus Microfracture in Arthroscopic Treatment of Talar Osteochondral Lesions

Category: Ankle Introduction/Purpose: There are few prior investigations that report the clinical and radiographic outcomes of juvenile allogenic chondrocyte implantation with autologous bone marrow aspirate in the ankle. Reports that do exist have offered conflicting results and suggest that this relatively new technique has no significant advantage over current repair techniques. The purpose of this study was to compare the functional and radiographic outcomes of patients who received juvenile allogenic chondrocyte implantation with autologous bone marrow aspirate for treatment of talar osteochondral lesions with those of patients who underwent microfracture. Methods: After approval was obtained from our institutional review board, the institution’s foot and ankle registry was searched using relevant Current Procedural Terminology codes for all patients who underwent either microfracture or juvenile allogenic chondrocyte implantation with bone marrow aspirate concentrate for an osteochondral lesion of the talus between 2006 and 2014. Ninety-six patients fit the inclusion criteria and composed the study cohort. Of these 96 patients, 50 had undergone microfracture treatment and 46 had received DeNovo NT for juvenile allogenic chondrocyte implantation with bone marrow aspirate concentrate treatment, composing the microfracture (MF) and JACI-BMAC groups, respectively. Retrospective chart review was performed and functional outcomes were assessed pre- and postoperatively using the Foot and Ankle Outcome Score (FAOS) and Short Form-12 (SF-12) general health questionnaire. Postoperative magnetic resonance (MR) images were reviewed and evaluated using a modified Magnetic Resonance Observation of Cartilage Tissue (MOCART) score. Results: The average followup was 40.0 (range 5.0 to 113.6) months with the MF group having an average followup of 40.3 months (range 5 to 133.6) and the JACI-BMAC group averaging a 18.6 month followup (range 9.1 to 39.6). Both the JACI-BMAC and MF groups had significant pre-to-postoperative improvements in Pain, Daily Activities, Sports, Quality of Life, and overall FAOS Scores; however, there were no significant differences in any patient reported outcomes between the groups. SF-12 scores were improved in both JACI-BMAC and MF groups, however the MF change from pre- to-postoperative did not reach significance (p = 0.214). Radiographically, both the JACI-BMAC and MF groups produced reparative tissue that exhibited a fibrocartilage composition. The JACI-BMAC group tended to have more patients with hypertrophy exhibited on MR imaging than the MF group (p = 0.030). Conclusion: Juvenile allogenic chondrocyte implantation and microfracture resulted in improved functional outcomes. However, none of the differences in FAOS scores between groups achieved the minimal clinically important difference, suggesting there may not be enough of a difference between these treatments to distinguish them in terms of patient outcomes in the short term. Both techniques produced reparative tissue that exhibited fibrocartilage composition radiographically. Based on our results, juvenile allogenous cartilage has not demonstrated a significant advantage over the microfracture technique in the treatment of talar osteochondral lesions. Longer term studies will be needed to see if these findings are maintained over time.

Bone Marrow Injection for Treatment of Aneurysmal Bone Cyst

Study design: Patients had Aneurysmal bone cyst lesion that underwent to be treated by Injection of Autologous Bone Marrow Aspirates (ABM) and follow up of this case for the final results. Patients and Methods: Sixteen patients had had Aneurysmal bone cyst had been treated by ABM injections. Study have 16 patients 11 females (68.75 %) and 5 male (31.25 %). Age ranged from 3-14 years with average age 7.5 years. Number of injections for every patient ranged from 2-6 times with average 4.4 times. This study including 5 cases (31.25 %) with proximal femoral cyst, 9 cases (56.25 %) had tibial cyst (2 distal and 7 proximal tibiea) and 2 cases (12.5 %) had proximal humeral cyst. All patients treated by injection of Autologous Bone Marrow Aspirates which obtained from the iliac crest. The bone marrow aspirates was obtained percutaneous by bone marrow aspiration needle, According to follow up X-ray during injections we decide continuity of injections. Average size of the defect was 2.3 cm. and average amount bone marrow/inj. Was 10.2 cc. Results: Pain Score according to VAS ranged from 3-9 with average 5.7 which was improved to average 1.5 at final follow up. Healing time ranged from 21 - 90 days with average 42.2 days. Motion of the arm as patients can move their arm without pain was allowed. Weight bearing for the lower limbs also had been allowed as patients felt pain subsided even there is no complete healing radiological. Conclusion: Aneurysmal Bone cyst has risk for fracture and recurrence after various modalities of treatment. Bone marrow has the advantage of percutaneous treatment (minimal Invasive) and has no recurrence reported for the current study.

Repair Potential of Matrix-Induced Bone Marrow Aspirate Concentrate and Matrix-Induced Autologous Chondrocyte Implantation for Talar Osteochondral Repair

The low regenerative potential of cartilage contributed to the development of different cell therapies aimed to improve the clinical outcome in young patients with Osteochondral Lesions of the Talus (OLT). This study is designed to assess the regenerative potential of autologous matrix-induced Bone Marrow Aspirate Concentrate (mBMAC) and matrix-induced Autologous Chondrocyte Implantation (mACI) evaluating, on a small number of osteochondral biopsies, the expression of some catabolic, inflammatory, and pain mediators. Twenty-two patients with OLT were analyzed in this study; 7 were treated with mACI and 15 with mBMAC. Informed consent was obtained from all the patients. Clinical assessments were performed pre-operatively and at 12, 24, and 36 months after surgery using the American Orthopedic Foot and Ankle Society (AOFAS). Histology and immunohistochemistry were used to assess cartilage repair at 24 months. Data were analyzed using non-parametric Wilcoxon-Mann-Whitney and Spearman tests. A remarkable improvement in AOFAS score was noticed for both treatments up to 36 months; however, patients treated with mACI reported the best AOFAS score. Various degrees of tissue remodeling were observed by histological analysis for both cell strategies. However, mBMAC treatment showed a higher expression of some fibrous and hypertrophic markers compared to mACI group. A mild positivity for nerve growth factor, as pain mediator, was noticed for both treatments.M. Our findings demonstrated the best histological and clinical results following mACI treatment since different fibrotic and hypertrophic features were evident in the mBMAC group at 24-month follow-up.