Bone Marrow Aspirate Concentrate Research Articles

Bone marrow aspirate concentrate and platelet-rich fibrin in fresh extraction sockets: A histomorphometric and immunohistochemical study in humans

The aim of this study was to evaluate the level of mineralized tissue and expression of bone markers in sockets grafted with platelet-rich fibrin and bone marrow aspirate concentrate (BMAC).Patients requiring extraction of one maxillary anterior tooth were randomized into three groups. After tooth extraction, the sockets in the control group (CG) were permitted to fill with blood clot. In the platelet-rich fibrin group (PRFG), after blood processing, the sockets were grafted with PRF plug. In the bone marrow aspirate concentrate combined with platelet-rich fibrin group (BM/PG), after blood and bone marrow processing, the sockets were grafted with a mixture of PRF plug and BMAC. After 6 months, the sites were reopened and bone cores were harvested and prepared for histomorphometric and immunohistochemical evaluation. The following levels were measured: mineralized tissue, expression of RUNX-2, and osteocalcin.Fifteen patients were included in this study. The histomorphometric analysis showed a more pronounced level of mineralized tissue in PRFG and BM/PG (54.20 ± 4.31% and 64.70 ± 6.74%, respectively) when compared with CG (40.60 ± 5.98%) (p = 0.0283 and p = 0.0090, respectively). The expression of RUNX-2 was very low in BM/PG (0.80 ± 0.84%) and absent in CG and PRFG (p = 0.0528). Osteocalcin expression was higher for BM/PG (23.40 ± 1.52%) when compared with CG and PRFG (18.40 ± 2.07% and 16.20 ± 1.92%, respectively) (p = 0.0117 and p = 0.0088, respectively).This preliminary study indicates that clinical use of bone marrow aspirate concentrate, when combined with platelet-rich fibrin as a carrier, might have some potential to increase mineralization in fresh extraction sockets.

The Radiographic Effect of Bone Marrow Aspirate Concentrate on Bone Maturation During Mandibular Distraction Osteogenesis.

This study aims to evaluate the effect of bone marrow aspirate concentrate (BMAC) during distraction on the consolidation period. The study had 2 groups each had 6 patients. In the control, the distraction had no enhancement; while, the study group was enhanced by BMAC. The bone quality and quantity were assessed using cone beam computed tomography (CBCT). The assessment of bone density showed non-significant (NS) (P = 0.06) increase in bone density in the study group (M = 293 ± 100 HU) compared to the control group (M = 176 ± 94 HU). The Assessment of bone volume showed a NS (P = 0.15) increase in bone volume in Study group with average bone volume/total volume (M = 49.47% ± 4.5%) compared to Control group (M = 43.9% ± 7.5%). Further examination is recommended to evaluate the effect of BMAC on the distracted bone. The addition of BMAC made a non-significant improvement in bone quantity and quality.

Efficacy of orthobiologic adjuvants to core decompression for hip preservation in avascular necrosis hip.

Head preserving modalities in avascular necrosis (AVN) hip are variably effective in early stages, and further options that could prevent head distortion and osteoarthritis are needed. Core decompression (CD) is the most commonly used surgery in the early stages of osteonecrosis with variable rates of success. The present review aimed to determine the effectiveness of bone marrow aspirate concentrate (BMAC), platelet-rich plasma (PRP), bone morphogenetic proteins (BMP) or their combination with CD in early stages of AVN hip, prior to collapse of femoral head. Additionally, any newer unexplored modalities were also searched for and ascertained. PubMed and SCOPUS databases were searched for relevant articles in English language describing CD with aforementioned orthobiologics. We analysed a total of 20 studies published between 2011 and 2020. There were 6 retrospective and 14 prospective studies. PRP showed improved survival and functional outcomes; however, with only three studies, there is inconclusive evidence for its routine utilization. BMAC enhances the efficacy of CD which can further be increased by culture and expansion of cells or combining it with PRP to stimulate growth. In conclusion, CD with BMAC works more efficiently than CD alone prior to collapse of femoral head in AVN. However, PRP needs more evidence for extensive application. Addition of PRP to BMAC or culturing the latter could further enhance the potency of CD + BMAC combination. Very limited data is available for the efficacy of BMP-7 and the role of intraosseous bisphosphonates should be evaluated for a cheaper and potential alternative.

Mechanically superior matrices promote osteointegration and regeneration of anterior cruciate ligament tissue in rabbits

The gold standard treatment for anterior cruciate ligament (ACL) reconstruction is the use of tendon autografts and allografts. Limiting factors for this treatment include donor site morbidity, potential disease transmission, and variable graft quality. To address these limitations, we previously developed an off-the-shelf alternative, a poly(l-lactic) acid (PLLA) bioengineered ACL matrix, and demonstrated its feasibility to regenerate ACL tissue. This study aims to 1) accelerate the rate of regeneration using the bioengineered ACL matrix by supplementation with bone marrow aspirate concentrate (BMAC) and growth factors (BMP-2, FGF-2, and FGF-8) and 2) increase matrix strength retention. Histological evaluation showed robust tissue regeneration in all groups. The presence of cuboidal cells reminiscent of ACL fibroblasts and chondrocytes surrounded by an extracellular matrix rich in anionic macromolecules was up-regulated in the BMAC group. This was not observed in previous studies and is indicative of enhanced regeneration. Additionally, intraarticular treatment with FGF-2 and FGF-8 was found to suppress joint inflammation. To increase matrix strength retention, we incorporated nondegradable fibers, polyethylene terephthalate (PET), into the PLLA bioengineered ACL matrix to fabricate a "tiger graft." The tiger graft demonstrated the greatest peak loads among the experimental groups and the highest to date in a rabbit model. Moreover, the tiger graft showed superior osteointegration, making it an ideal bioengineered ACL matrix. The results of this study illustrate the beneficial effect bioactive factors and PET incorporation have on ACL regeneration and signal a promising step toward the clinical translation of a functional bioengineered ACL matrix.

Hemovac blood after total knee arthroplasty as a source of stem cells.

BackgroundWith increasing life expectancy, stem cell therapy is receiving increasing attention. However, its application is restricted by ethical concerns. Hence a need exists for design of safe procedures for stem cell procurement. Here, we investigated whether hemovac blood (HVB) is an appropriate stem cell source.MethodsHVB concentrates (HVBCs) from 20 total knee arthroplasty (TKA) patients and bone marrow aspirate (BMA) concentrates (BMACs) from 15 patients who underwent knee cartilage repair were comparatively evaluated. A bone marrow aspiration needle was inserted into the anterior superior iliac spine. Aspiration was performed using a 50-mL syringe, including 4 mL of anticoagulant, followed by centrifugation to obtain BMACs. To obtain HVBCs, blood was aspirated from the hemovac immediately after TKA surgery. Different cell types were enumerated. Isolation of BMA and HVB mononuclear cells was performed using density gradient centrifugation. Non-hematopoietic fibroblast colonies were quantified by colony forming unit-fibroblast assay surface marker analysis of HVB, HVBC, BMA, and BMAC was performed via flow cytometry. Mesenchymal stem cells (MSCs) isolated from HVBCs and BMACs were examined for osteogenic, adipogenic, and chondrogenic differentiation potential. Gene expression analysis was performed by quantitative real-time polymerase chain reaction (qRT-PCR).ResultsThe number of cells from HVB and HVBC was significantly lower than from BMA and BMAC; however, the number of colonies in HVBC and BMAC did not differ significantly (P>0.05). Isolated cells from both sources had a fibroblast-like appearance, adhered to culture flasks, and formed colonies. Under different culture conditions, MSC-specific surface markers (CD29, CD44, CD90, CD105), osteogenic markers [RUNX2, osteopontin, osteocalcin, and alkaline phosphatase (ALP)] and adipogenic markers (PPARγ and C/EBPα) were expressed. Moreover, SOX9, type II collagen, and aggrecan were significantly upregulated upon chondrogenic differentiation.ConclusionsHVB from TKA patients is a useful source of stem cells for research.

Inflammation, Bone Healing and Osteonecrosis: From Bedside to Bench.

Osteonecrosis of the epiphyseal and metaphyseal regions of major weight-bearing bones of the extremities is a condition that is associated with local death of bone cells and marrow in the afflicted compartment. Chronic inflammation is a prominent feature of osteonecrosis. If the persistent inflammation is not resolved, this process will result in progressive collapse and subsequent degenerative arthritis. In the pre-collapse stage of osteonecrosis, attempt at joint preservation rather than joint replacement in this younger population with osteonecrosis is a major clinical objective. In this regard, core decompression, with/without local injection of bone marrow aspirate concentrate (BMAC), is an accepted and evidence-based method to help arrest the progression and improve the outcome of early-stage osteonecrosis. However, some patients do not respond favorably to this treatment. Thus, it is prudent to consider strategies to mitigate chronic inflammation concurrent with addressing the deficiencies in osteogenesis and vasculogenesis in order to save the affected joint. Interestingly, the processes of inflammation, osteonecrosis, and bone healing are highly inter-related. Therefore, modulating the biological processes and crosstalk among cells of the innate immune system, the mesenchymal stem cell-osteoblast lineage and others are important to providing the local microenvironment for resolution of inflammation and subsequent repair. This review summarizes the clinical and biologic principles associated with osteonecrosis and provides potential cutting-end strategies for modulating chronic inflammation and facilitating osteogenesis and vasculogenesis using local interventions. Although these studies are still in the preclinical stages, it is hoped that safe, efficacious, and cost-effective interventions will be developed to save the host’s natural joint.

Preliminary Clinical Outcomes Following Biologic Augmentation of Arthroscopic Rotator Cuff Repair Using Subacromial Bursa, Concentrated Bone Marrow Aspirate, and Platelet-Rich Plasma

PurposeTo evaluate the clinical outcomes of patients who underwent arthroscopic rotator cuff repair augmented using subacromial bursa, concentrated bone marrow aspirate (cBMA), and platelet-rich plasma.MethodsSixteen patients were included in the study who underwent arthroscopic rotator cuff repair augmented using subacromial bursa, cBMA, and platelet-rich plasma from January 2018 to July 2018 and had a minimum 1-year follow-up. American Shoulder and Elbow Surgeons (ASES), Simple Shoulder Test, Constant-Murley, and Single Assessment Numerical Evaluation (SANE) scores were collected preoperatively and at terminal follow-up. To determine the clinical relevance of ASES scores, the minimal clinically important difference, substantial clinical benefit, and the patient acceptable symptomatic state thresholds were used. In vitro cellular proliferation of subacromial bursa (nucleated cells/gram) and cBMA (nucleated cells and colony-forming units/cc) samples was evaluated and correlated to clinical outcomes scores.ResultsMean follow-up was 12.6 ± 1.8 months (range 12-19 months). Patients achieved significant improvement in ASES (45.8±22.5pre vs 88.5 ± 14.6post, Δ44.7 ± 20.7; P = .001), Simple Shoulder Test (4.3 ± 3.2pre vs 10.4 ± 1.6post, Δ5.7 ± 3.9, P = .002), Constant-Murley (44.3 ± 18.2pre vs 83.6 ± 17.5post, Δ37.2 ± 21.8; P = .001), SANE (13.3 ± 10.7pre vs 86.3 ± 17.5post, Δ71.9 ± 22.9; P = .001), and pain scores (5.0±2.8pre vs 1.1 ± 1.6post, Δ3.5±2.5, P = .001) at final follow-up. With regards to ASES score, 93.8% of patients achieved the minimal clinically important difference, 93.8% the substantial clinical benefit, and 62.5% reached or exceeded the patient acceptable symptomatic state criteria. There was a significant positive correlation of nucleated cell count of cBMA with postoperative SANE score (r = 0.707; P = .015) and delta in ASES score (r = 0.727; P = .011). All other correlations were found to be nonsignificant (P > .05, respectively).ConclusionsPatients undergoing arthroscopic rotator cuff repair augmented using the Mega-Clot with bursa technique achieved significant improvement in functional outcomes at a minimum 1-year follow-up, with 93.8% of patients reaching substantial clinical benefit.Level of EvidenceLevel IV, therapeutic case series.

Pain Scores and Return to Activities/Sport Following Dehydrated Micronized Allogenic Cartilage and Isolated Microfracture for Treatment of Talar Osteochondral Lesions

Category:SportsIntroduction/Purpose:Osteochondral lesions of the talus (OLT) are common injuries, however management remains challenging. Lesion size remains a common determinant of treatment and microfracture remains common for smaller lesions. Microfracture provides access to mesenchymal stem cells within the subchondral bone. Dehydrated micronized allogenic cartilage (DMAC) (BioCartilage, Arthrex, Naples, FL) utilizes a single stage attempt to augment microfracture with a scaffold over the defect to improve hyaline cartilage restoration. DMAC requires hydration with plasma rich protein (PRP) or bone marrow aspirate concentrate (BMAC). Currently, there is limited literature on pain scores and return-to-activities and satisfactory return- to-sport following DMAC treatments. The purpose of this study is to report pain scores, percent and time return-to -activities, percent and time to satisfactory return-to-sport following microfracture + DMAC and isolated microfracture.Methods:We reviewed a series of 65 cases (37 female and 28 male; mean age 34.6 (SD 14.1); mean BMI 27.3 (SD 6.2)) between 2010 and 2019 in which surgical treatment for OLT consisted of microfracture + DMAC, or isolated microfracture. Surgical procedure was determined by treating surgeon. Demographic, visual analog scale (VAS) pain scores (0-10), return-to-activities, and satisfactory-return-to-sport were collected preoperatively and postoperatively at 3-months, 6-months, and 1 year. Return-to- activities was defined as any engagement in desired activities, whereas satisfactory-return-to-sport was determined by patient- report. T-tests were used to determine between group differences.Results:Sixty-five cases (DMAC 25; isolated-microfracture: 40) demonstrated mean pain score at 3-months for DMAC and isolated-microfracture of 0.8 and 2.0, respectively, (p=0.04). There were no significant differences in remaining pain scores. By 1- year, 100% of DMAC and 87.5% of isolated-microfracture returned-to-activities, p=0.09. Of those that returned-to-activities there was no difference in time-to-return-to-activities between groups 82.9 days vs 82.4 days. By 1-year, patients that return-to-sport demonstrated a patient-reported satisfactory-level-of-return of 52.0% in DMAC and 37.5% in isolated-microfracture. Of those that returned satisfactorily-to-sport, the time-to-satisfactory-return-to-sport was similar (mean 139.5 and 135.7 days, p=0.66). A subgroup analysis of microfracture + DMAC group determined that PRP (n=16) had less pain at 3 months than BMAC (n=9), mean 0.8 vs 2.0, respectively; p=0.03, with no other differences noted (p>0.05).Conclusion:The use of microfracture + DMAC may improve early post-operative pain scores and improve ability to return to a patient-reported satisfactory level of sport by 1-year. Isolated microfracture and DMAC augmentation had similar rates and times to return-to-activities, and pain levels after 6-months post-operatively. The use of PRP to supplement DMAC improved early post- operative pain scores compared to BMAC which may be related to donor-site morbidity. Otherwise PRP and BMAC supplementation of DMAC had similar subsequent pain scores, and rate and time to return to activities. Augmentation of microfracture with DMAC for OLTs may improve outcomes compared to microfracture alone.

Functional and Radiographic Outcomes Following Repair of Osteochondral Lesions After Ankle Fracture with Arthrex BioCartilage and Bone Marrow Aspirate Concentrate compared to Microfracture

Category:Arthroscopy; Basic Sciences/Biologics; TraumaIntroduction/Purpose:There has been an increasing role for arthroscopy in ankle fracture fixation, particularly in assessing osteochondral lesions (OCL). Initial cartilage damage has been found to be an independent risk factor for post-traumatic ankle arthritis. Rates of osteochondral injury with ankle fracture remain varied, but have been reported up to 62-80%. Treatment for osteochondral injuries classically included debridement alone or debridement with microfracture. Recently, new biologic augments have come to market, including BioCartilage (Arthrex): a mixture of cadaveric articular cartilage extracellular matrix. This has been used in conjunction with bone marrow aspirate concentrate (BMAC). To date, no study has evaluated the outcomes of utilizing BioCartilage in the treatment of osteochondral lesions, or in comparison to microfracture alone, in conjunction with ankle fracture fixation.Methods:We conducted a retrospective analysis of all adult patients (age > 18) undergoing operative ankle fracture or syndesmotic fixation with concomitant ankle arthroscopy utilizing our Foot and Ankle Registry. Institutional Review Board (IRB) approval was obtained prior to data collection. Patient demographic data, laterality, fracture pattern and OCL size were documented. Those with full-thickness lesions requiring treatment were divided into groups based on the use of Biocartilage + BMAC or microfracture alone. Exclusion criteria included pediatric patients, distal tibia intra-articular, and open fractures.Outcome scores for pre- and postoperative patient reported outcome measures (PROMIS) were recorded, with a minimum 6- month follow up. Magnetic resonance observation of cartilage repair tissue (MOCART) scoring was performed for those with postoperative MRIs to evaluate OCL healing. We also included a group that had ankle fracture fixation and arthroscopy but without any osteochondral lesion to serve as a control.Results:28 patients were treated with Biocartilage/BMAC; 19 with preoperative and 17 with postoperative PROMIS. 41 patients had microfracture; 20 with preoperative and 18 with postoperative PROMIS. 75 patients were identified in the non-OCL group; 60 with preoperative and 45 with postoperative PROMIS. Average follow-up was 20.61 months. There were no significant differences in postoperative PROMIS scores between the two treatment groups in all sub-categories. When comparing each treatment group to the control, there was a statistically significant increase in pre to postoperative global physical health scores for the non-OCL group compared to Biocartilage/BMAC. Postoperative MRIs were obtained in 12/28 patients with Biocartilage/BMAC and 10 /41 with microfracture. There was no significant difference between either group in overall MOCART scores or individual scoring categories.Conclusion:The role for arthroscopy in ankle fracture fixation is evolving, as is the treatment of identifiable osteochondral lesions. We sought to compare a novel biologic technique of Biocartilage and BMAC with microfracture for OCL management. Our results demonstrated no significant difference between treatments for postoperative PROMIS and MOCART scores.Outcome measures did not differ significantly when compared to our control group. Unfortunately, complete PROMIS and MOCART data was lacking in each group, limiting the ability to draw definitive conclusions. However, we believe this is a positive first step in understanding the role in treating osteochondral lesions associated with ankle fractures.

Comparison Matrix-Associated Stem Cell Transplantation (MAST) with Autologous Matrix Induced Chondrogenesis plus Peripheral Blood Concentrate (AMIC+PBC) in Chondral Lesions at the Ankle - Matched-Patient Analysis

Category:AnkleIntroduction/Purpose:2016, the local government authorities re-categorized MAST, i.e. the included BMAC for impregnation of the matrix, as stem call manufacturing and heterologous transplantation. Consequently, MAST and all other procedures including BMAC were not ‘subject to disclosure’ as before but ‘subject to authorization’. Therefore, the authors´ institution was not authorized to perform MAST after July 16, 2016. The authors´ institution changed the treatment of chondral lesions by replacing BMAC as part of MAST to Peripheral Blood Concentrate (PBC) resulting in AMIC+PBC.The aim of the study was to compare MAST with AMIC+PBC in chondral lesions at the ankle.Methods:In a matched-patient clinical follow-up study, patients with chondral lesion at the ankle that were treated with AMIC+PBC from July 17, 2016 to May 31, 2017, and patients that were treated with MAST from April 1, 2009 to July 15, 2016 were included and compared. Size and location of the chondral lesions and the Visual-Analogue-Scale Foot and Ankle (VAS FA) before treatment and at follow-up were analysed. Bone Marrow Aspirate Concentrate (BMAC) was used for MAST and Peripheral Blood Concentrate (PBC) for AMIC+PBC to impregnate a collagen I/III matrix (Chondro-Gide, Wollhusen, Switzerland) that was fixed into the chondral lesion with fibrin glue.Results:One hundred and twenty-nine patients with 136 chondral lesions were included in both groups. The chondral lesions were located as follows (MAST/AMIC+PBC, n (%)), medial talar shoulder only, 59 (43)/62 (46); lateral talar shoulder only, 44 (32)/42 (31); medial and lateral talar shoulder, 7 (10)/7 (10); tibia, 19 (14)/18 (13). The lesion size was 1.6/1.8cm2 on average and VAS FA was 46.9/45.7 (MAST/AMIC+PBC). For MAST/AMIC+PBC groups, 107 (83%)/105 (81%) with 112/110 previous chondral lesions completed the defined 2-year-follow-up after 24.4/23.8 months on average. VAS FA improved to 82.3/79.8 (MAST/AMIC+PBC). No parameter significantly differed between MAST and AMIC+PBC groups.Conclusion:MAST and AMIC+PBC as part of a complex surgical approach led to improved and high validated outcome scores in 2-year-follow-up. MAST and AMIC+PBC showed similar results. No method related complications were registered.

Bone marrow aspirate concentrate (Stem cells) therapy for pre-collapse stage of AVN of femoral head: An interventional comparative study

Introduction: Osteonecrosis of the hip is an incapacitating disease where the goal of management is to diagnose and treat it early in the pre-collapse stage. Core decompression (CD) is an established modality to treat the pre- collapse stage. We aimed to evaluate the outcome of CD alone versus CD with Bone Marrow Aspirate Concentrate infiltration. Materials and Methods: We conducted a retrospective cum prospective cross sectional randomized study comparing CD and CD + BMAC. Post-operative radiographs were taken and the patient was reviewed every 3 months with radiographs. Harris Hip score (HHS) and Visual Analog Scale (VAS) score were assessed on the follow up. A paired-T test was used for analysis of results. Results: 23 patients (32 hips) were included in which 15 hips were treated in the form of CD+ BMAC and 17 hips treated with CD alone with a mean follow up 14.4 months for the study. There was significantly lowered Harris Hip Score in the Core Decompression group and a significantly lowered VAS score (i.e. reduced pain) in the Core Decompression + BMAC group. As compared to the pre-op Harris hip Score, the follow up HHS increased in 8 of the 15 patients in CD+BMAC group and 2 of the 17 patients in CD group. As compared to the pre-op VAS Score, the follow up VAS reduced in 8 of the 15 patients in CD+BMAC group and 2 of the 17 patients in CD group. Conclusion: Our study concludes that BMAC + CD is a safe, efficient and a less technically demanding modality for the treatment of non-traumatic avascular necrosis of femoral head in pre-collapse stage. BMAC significantly improves the results of Core decompression both functionally and radiologically. Patient satisfaction and pain relief is better than CD alone.

Bone Marrow Aspirate Concentrate Is Equivalent to PRP for the Treatment of Knee OA at 1 Year: Response.

Bone Marrow Aspirate Concentrate Is Equivalent to PRP for the Treatment of Knee OA at 1 Year: Response.

Bone Marrow Aspirate Concentrate Is Equivalent to PRP for the Treatment of Knee OA at 1 Year: Letter to the Editor.

Bone Marrow Aspirate Concentrate Is Equivalent to PRP for the Treatment of Knee OA at 1 Year: Letter to the Editor.

Positive early clinical outcomes of bone marrow aspirate concentrate for osteoarthritis using a novel fenestrated trocar

BackgroundThis study sought to assess early clinical outcomes for knee osteoarthritis (OA) patients undergoing bone marrow aspirate concentrate (BMAC) treatment using a novel closed-end, fenestrated trocar (FT) that does not require centrifugation. MethodsA prospective cohort of 17 knee OA patients undergoing BMAC treatment with the FT system from March 2018 to March 2019 was retrospectively evaluated. Approximately 10 mL of BMAC was harvested, no centrifugation was performed, and the BMAC was injected into the affected knee. Clinical outcomes were assessed at baseline, six weeks, and 12 weeks. This study has no affiliation with/vested-interest in the FT system. ResultsThere were significant improvements in nearly all outcomes from baseline to 12 weeks. Specific improvements included Knee Injury and OA Outcome Score (KOOS) activities-of-daily-living (61.1 ± 9.2 [mean ± 95% confidence interval] to 89.3 ± 6, p = 0.001), quality-of-life (32.7 ± 9.3 to 66.1 ± 17.9, p = 0.003), sports/recreation (36.9 ± 10.6 to 72.6 ± 26.3, p = 0.006), and pain (53.8 ± 9.3 to 83 ± 10.2, p = 0.001); Lysholm scores (55.5 ± 8.4 to 77.3 ± 10.5, p = 0.009); and visual analog pain scores (5.68 ± 1.14 to 2.07 ± 1.86, p = 0.003). Individually, at least 75% of patients exhibited improvement in all KOOS categories at six weeks and at least 85% at 12 weeks. ConclusionsBMAC treatment with an FT system that does not require centrifugation resulted in significant improvements in early pain and function scores for knee OA. The symptomatic improvements in this study were similar to or greater than what has been reported using traditional needles. These data may provide clinicians with comfort in using an FT system and provide motivation for future randomized-controlled trials comparing aspiration techniques.

Treatment of infected tibial non-unions using a BMAC and S53P4 BAG combination for reconstruction of segmental bone defects: A clinical case series.

Treatment of infected non-unions of the tibia is a challenging problem. The cornerstones of optimal infected non-union treatment consist of extensive debridement, fracture fixation, antimicrobial therapy and creation of an optimal local biological bone healing environment. The combination of S53P4 bioactive glass (BAG), as osteostimulative antibacterial bone graft substitute, and bone marrow aspirate concentrate (BMAC) for the implantation of mesenchymal stem cells and growth factors might be a promising combination. In this paper, preliminary results of a new treatment algorithm for infected non-unions of the tibia is presented. In this retrospective case series patients with infected non-unions of the tibia are treated according to a new treatment algorithm. Patients are treated with extensive debridement surgery, replacement of the osteosynthesis and implantation of S53P4 BAG and BMAC in a one-stage or two-stage procedure based on non-union severity. Subsequently patients are treated with culture based antibiotic therapy and followed until union and infection eradication. Five patients with an infected non-union were treated, mean age was 55, average NUSS-score was 44 and the average segmental bone defect was 4.6cm. One patient was treated in a one-stage procedure and four patients in a two-stage induced membrane-, or "Masquelet"-procedure. On average, 23 ml S53P4 BAG and 6.2 ml BMAC was implanted. The mean follow-up period was 13.6 months and at the end of follow-up all patients had clinical consolidation with an average RUST-score of 7.8 and complete eradication of infection. These early data on the combined implantation of S53P4 BAG and BMAC in treatment of infected non-unions shows promising results. These fracture healing results and eradication rates resulted in promising functional recovery of the patients. To substantiate these results, larger and higher quality studies should be performed.

Corrigendum: Operative Treatment for Osteochondral Lesions of the Talus: Bone Marrow Aspirate Concentrate and Matrix-induced Chondrogenesis

Corrigendum: Operative Treatment for Osteochondral Lesions of the Talus: Bone Marrow Aspirate Concentrate and Matrix-induced Chondrogenesis

Effectiveness of percutaneous injection of autologous concentrated bone marrow aspirate combined with platelet-rich plasma in treatment of delayed fracture healing

To analyze the effectiveness of percutaneous injection of autologous concentrated bone marrow aspirate (cBMA) combined with platelet-rich plasma (PRP) in the treatment of delayed fracture healing. A prospective, randomized, controlled, single-blind case study was conducted. Between March 2016 and July 2018, 66 patients who met the inclusion and exclusion criteria for delayed fracture healing but had solid internal fixation of the fracture end were randomly divided into control group (31 cases, treated with percutaneous autogenous bone marrow blood injection) and study group (35 cases, treated with percutaneous autogenous cBMA+PRP injection). General data such as gender, age, body mass index, site of delayed fracture healing, length of bone defect at fracture end, and preoperative radiographic union score for tibia (RUST) showed no significant difference between the two groups ( P>0.05). Before injection, Kirschner wire was used in both groups to stimulate the fracture end and cause minor injury. The fracture healing time, treatment cost, and adverse reactions were recorded and compared between the two groups. Visual analogue scale (VAS) score was used to evaluate pain improvement. The tibial RUST score was extended to the tubular bone healing evaluation. No infection of bone marrow puncture needle eyes occurred in both groups. In the control group, local swelling was obvious in 5 cases and pain was aggravated at 1 day after operation in 11 cases. In the study group, postoperative swelling and pain were not obvious, but 2 cases presented local swelling and pain. All of them relieved after symptomatic treatment. Patients in both groups were followed up, the follow-up time of the control group was 16-36 months (mean, 21.8 months), and the study group lasted 14-33 months (mean, 23.2 months). The amount of bone marrow blood was significantly lower in the study group than in the control group ( t=4.610, P=0.000). The degree of postoperative pain in the study group was less than that in the control group, and the treatment cost was higher than that in the control group. But the differences between the two groups in VAS score at 1 day after operation and treatment cost were not significant ( P>0.05). Fracture healing was achieved in 19 cases (61.3%) in the control group and 30 cases (85.7%) in the study group. The difference in fracture healing rate between the two groups was significant ( χ 2=5.128, P=0.024). Fracture healing time and RUST score at last follow-up were significantly better in the study group than in the control group ( P<0.05). At last follow-up, RUST scores in both groups were significantly improved when compared with those before operation ( P<0.05). Autogenous cBMA combined with PRP percutaneous injection can provide high concentration of BMSCs and growth factors, and can improve the fracture healing rate and shorten the fracture healing time better than autogenous bone marrow blood injection.

Analysis of Time to Form Colony Units for Connective Tissue Progenitor Cells (Stem Cells) Harvested From Concentrated Bone Marrow Aspirate and Subacromial Bursa Tissue in Patients Undergoing Rotator Cuff Repair

PurposeTo evaluate the time required for colonies to develop from concentrated bone marrow aspirate (cBMA) and subacromial bursal tissue samples.MethodsSamples of cBMA and subacromial bursa tissue were harvested from patients undergoing rotator cuff repair surgery between November 2014 and December 2019. Samples were analyzed for time to form colonies and number of colonies formed. The impact of age, sex, and cellularity (cBMA only) was analyzed. Samples were cultured and evaluated daily for colony formation in accordance with the guidelines of the International Society for Cellular Therapy. Demographic factors were analyzed for impact on time to form colonies and number of colonies formed.ResultsSamples of cBMA were obtained from 92 patients. Subacromial bursa tissue was obtained from 54 patients. For cBMA, older age was associated with more days to form colonies (P = .003), but sex (P = .955) and cellularity (P = .623) were not. For bursa, increased age was associated with longer time to form colonies (P = .002) but not sex (P = .804). Conclusions: Increased age (in cBMA and subacromial bursa tissue) and lower initial cellularity (in cBMA) are associated with longer time to form colonies in culture.Clinical RelevanceAlthough connective tissue progenitor cells are widely used in orthopaedic practice, there are few metrics to determine their efficacy. Time to form colonies may serve as an important measurement for determining connective tissue progenitor cell viability for augmentation of rotator cuff repair. Subacromial bursa tissue may represent a viable alternative to cBMA for augmentation of rotator cuff repair, capable of forming colonies expediently in vivo.

12. Health care costs and characteristics of spinal fusion patients receiving concentrated bone marrow aspirate (BMAC), iliac crest autograft or bone morphogenic protein (BMP) therapy: a retrospective cohort study utilizing administrative claims

BACKGROUND CONTEXT To aid in fusion, surgeons may choose to use a biologic or other grafting agent in posterior lumbar spinal fusion procedures. This study explored the differences in cost and a variety of outcomes of bone marrow aspirate concentrate (BMAC), iliac crest autogenous bone grafting (autograft) and recombinant human bone morphogenetic proteins (rhBMP) -2 and -7. Autograft complications include pain, risk of infection and donor morbidity. BMP drawbacks are high cost and at risk of stimulating too much bone growth. While BMAC has been shown to promote bone and soft tissue healing, possible risks include bleeding and infection or nerve damage. PURPOSE A market assessment was conducted to explore the clinical value of each product. The study also looked at patient demographics, outcomes, and cost across the grafting products. STUDY DESIGN/SETTING Retrospective administrative claims data from the Optum Commercial and Medicare Advantage affiliated claims dataset between January 1, 2016 and December 31, 2017. PATIENT SAMPLE The final study cohort consisted of 14,668 patients (BMAC: n=3,181; autograft: n=11,085; BMP: n=402) in the US. 84.5% (n=12,683) of patients had only 1 index procedure product and 97.2% (n=14,251) had a successful fusion. The majority of patients were aged 65+ (n=7,581 /52%), female (n=8,122 /55%), and received Medicare coverage (n=8,639 /59%). OUTCOME MEASURES Data on select patient demographic and clinical characteristic measures were collected, including Charlson Comorbidity Index (CCI) score and top AHRQ comorbidities. Inpatient and outpatient hospital costs, length of stay (LOS) and mean standardized cost per patient by procedure were among the data collected to drive the cost analysis. METHODS Patients with >= 1 a CPT code for a procedure of interest for autograft or BMAC or an ICD-10-PCS code for BMP of interest were identified during the study time period. Patients were indexed at admission date of MS-DRG involving first observed instance of a procedure of interest and required to have 6 months pre-and 12 months post-index continuous medical and pharmacy coverage. Data were analyzed using descriptive statistics. The mean differences in costs were assessed using Student's t-test for statistical significance. RESULTS The average length of stay (BMAC=3.6 days; autograft=3.8 days; BMP=4.3 days [p-value: BMAC vs autograft= CONCLUSIONS Data from this study showcases the cost savings and potential impact on health outcomes which can be incurred through the implementation of BMAC as a biologic in treating spine fusion patients. Given the rising cost of spinal fusion procedures performed annually in the US, further research should focus on evaluating the cost-effectiveness of the various procedures. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Arthroscopic Chondral Defect Repair With Extracellular Matrix Scaffold and Bone Marrow Aspirate Concentrate

Chondral defects of the knee are prevalent and often encountered during arthroscopic procedures. Despite the limited healing potential of chondral defects, several treatment options have been proposed. However, microfracture, osteochondral autograft (or allograft) transfer, autologous chondrocyte implantation, and matrix-induced autologous chondrocyte implantation are all associated with their respective shortcomings. As such, the optimal treatment for chondral defects of the knee remains unclear. Recently, many authors have advocated treating chondral defects with biological therapies and scaffold-based treatments. Bone marrow aspirate concentrate, a cell-based injection, has gained particular attention because of its differentiation capacity and potential role in tissue regeneration. In addition, scaffold cartilage treatments have emerged and reached clinical practice. BioCartilage is one form of scaffold, which consists of extracellular matrix, and has been claimed to promote the regeneration of hyaline-like cartilage. This article presents our technique of arthroscopic chondral defect repair using BMAC and BioCartilage.