Marrow Injection Research Articles

Сравнительный анализ результатов хирургического лечения несросшихся переломов и ложных суставов костей предплечья

Objective To compare outcomes of non-union in forearm fractures treated with the use of a comprehensive surgical approach considering the injury pattern and localization. Material and methods Based on treatment approaches the cases were categorized into 3 groups with proximal forearm fractures (group I, n = 28; 33.8 %), mid-shaft and distal forearm fractures (group II, n = 32; 38.5 %), and controls (group III, n = 23; 27.7 %). Group I included patients with hypertrophic nonunion (HTNU) of the forearm bones treated with bone graft and plating. Group II consisted of atrophic nonunion, HTNU of the forearm bones repaired with the Ilizarov external fixation. A single 3 mL local injection of autologous bone marrow and a kukumazim solution of 50 PU were used to induce bone fusion in the patients of the two groups. The control group included non-unions with no considerations to the fracture pattern and localization. All patients underwent physical, radiological examinations and laboratory tests. Results The control group showed 8.7 % poor and 69.5 % good outcomes at a long term, whereas 3.6 % results were rated as poor and 82.1 % as good in group I, with 3.1 % poor and 87.6 % good outcomes in group II. The ratings can be associated with a differentiated surgical approach considering the injury pattern and localization, the use of kukumazim proteolytic enzymes and autologous bone marrow injection. Conclusion Optimization of surgical treatments and considerations for injury pattern and localization allowed for a 2.8-time (3.1 %) decrease in poor outcomes and a 30 % reduction in the limb immobilization period.

Comparison of three treatment methods for simple bone cyst in children

BackgroundThe unicameral bone cyst (UBC) is a kind of benign tumor whose clinical treatments and efficacy are controversial. The purpose of this study was to evaluate the efficacy of the elastic stable intramedullary nail (ESIN), the injection of autologous bone marrow (ABM), and the combination of ESIN and ABM in the treatment of bone cyst in children.MethodsEighty-three cases with simple bone cyst were analyzed retrospectively. Twenty-eight cases were treated with ABM. Twenty-eight cases were treated with ESIN. Twenty-seven cases were treated with ABM and ESIN. All cases were diagnosed through X-ray, CT, or MRI scans. For the suspicious ones, the pathological biopsy was performed for an accurate diagnosis. X-ray examinations were carried out for the postoperative follow-up. Capanna criteria for bone cyst was used for postoperative evaluation of three methods.ResultsAll cases accomplished the follow-up. The effective rate of the ABM + ESIN group was significantly higher than that of the ABM group (P < 0.05), and the cure rates of the ESIN group and the ABM + ESIN group were higher than that of the ABM group (P < 0.05, respectively). The cure time in the ESIN group was lower than that of the other two groups (P < 0.05, respectively). The times for admission were 2.0 ± 0.0 in the ESIN group, 5.7 ± 1.9 in the ABM group, and 4.7 ± 2.4 in the ABM + ESIN group (P < 0.05 when compared with each other).ConclusionsThe method of ABM combined with ESIN for children’s bone cyst has the highest effective rate and curative rate. For the individual method, ESIN has a higher effective rate and curative rate than that of ABM. Meanwhile, it has the fewest time of hospitalization.

STUDY OF BONE MARROW ASPIRATE INJECTION EFFECT ON DENERVATED MUSCLE ACCORDING TO ELECTROMYOGRAPHY STUDIES

The aim. To study in experiment the effect of bone marrow aspirate injection on the course of denervation-reinnervation processes in skeletal muscle using neurophysiological research method. Materials and methods. Experimental study was performed on 36 mature rabbits weighing 3-4 kg. Experimental model of the peripheral nerve acute injury and neurorrhaphy is taken as a basis. Animals were divided into 4 groups of 9 animals per group (3 animals for each experimental period). At 8, 12, and 16 weeks after surgery, all rabbits underwent needle EMG of the target muscles (m. gastrocnemius, and m. tibialis anterior) to study denervation-reinnervation changes. Results. Results of target muscles electromyographic examination are shown. As norm, we took motor unit potentials parameters, which were registered during the study of contralateral (not operated) pelvic limbs. Largest number of registered MUPs at different stages of the denervation-reinnervation process was observed, and was significantly higher (α = 0.07) in the groups in which bone marrow aspirate was injected in relation to group without bone marrow aspirate injection. Changes in the parameters of the registered MUPs in all groups corresponded to the general characteristics of the denervation-reinnervation process. Conclusions. Injection of bone marrow aspirate into the target muscles during surgery and in the early stages of reinnervation (in experimental study it is 7 weeks after surgery) – reliably (α = 0.07) promotes improvement of reinnervation processes in muscles, which is manifested by registration of more motor unit potentials.

Abstract 15252: Ischemic-Trained Monocytes Improve Arteriogenesis During Hindlimb Ischemia

Introduction: Recent studies have shown that innate response can build immunological memory. This process called “trained immunity” is an epigenetic reprogramming of the monocytes driven by a metabolism shift towards glycolysis. Hypothesis: Since HIF-1a is a major player in monocytes activation and also targets some epigenetic enzymes, we hypothesize that hypoxia/ischemia can lead to “trained immunity” improving arteriogenesis in a mouse model of hindlimb ischemia. Methods: Mice subjected to a unilateral single ischemia insult for 24hours (24h group: femoral artery ligation for 24 h) or by ischemia reperfusion cycles (Cycle group: ischemia-reperfusion in 4 cycles of 5 minutes) or non-ischemia (sham group), were used as donors in the monocyte transfer experiment. Recipient mice underwent to permanent hindlimb ischemia one day prior the tail vein injection of bone marrow (BM) monocytes from the ischemic leg. Laser Doppler assessed blood flow recovery before and after hindlimb ischemia. Arteriogenesis was quantified on recipient mice by assessing the diameter of gracilis collaterals. A 24h group monocytes from ischemia and non-ischemia leg was used as donors to test the systemic vs. local effect of the ischemic-trained monocytes. Lin- cells were used as a control. Cultured human monocytes were subjected to 24h hypoxia and gene expression for epigenetic enzymes was performed by real time rt-PCR Results: Blood flow recovery in recipients who received ischemic-trained monocytes (24h and cycle) improved overtime compared to sham. Arteriogenesis was significant greater in 24h group compared to sham. Surprisingly, the improvement in blood flow recovery was abolished using combined monocytes from ischemic and non-sichemic, suggesting that ischemia training has a local effect in the monocytes. The Lin- experiment confirmed that the ischemia training is monocyte specific. Moreover, hypoxia regulated epigenetic enzymes responsible for histones methylation in human monocytes. Conclusions: Monocytes can be trained by previous ischemia/hypoxia insult and improve arteriogenesis during hindlimb ischemia. The molecular mechanisms that lead the trained immunity by hypoxia still unknown, however epigenetic modifications might play a role in this process.

RETROSPECTIVE ANALYSIS OF PATIENTS WITH SIMPLE BONE CYST

Introduction Simple bone cyst is benign fluid-filled lesion localized mainly in long bones. It is usually diagnosed in the first two decades, the most common in proximal humerus. Unicameral bone cyst is o›en asymptomatic but can cause pathological fracture. Aim of the study The aim of our study was to evaluate clinical, diagnostic and treatment factors concerning patients with simple bone cyst. Material and methods The retrospective analysis was performed on 22 patients treated in Department of Traumatology, Orthopaedics and Hand Surgery in Poznań between 2001 and 2017. We have analyzed epidemiological factors: age and sex; symptoms; clinical examination: range of motion, presence of pain; X-ray: localisation, cyst index of Kaelin and MacEwan and presence of pathological fractures; treatment: methods, number of hospitalizations and effectiveness. Results Mean age of patients was 10.8. From 22 patients 11 were females. Generally bone cyst was diagnosed because of pathological fracture – 18 patients (85.7%). Other reasons of X-ray diagnostic were: pain – 2 patients (9.1%), deformity – 1 patient (4.5%), incidentally – 2 patients (9.1%). The bone cyst was localized in humerus – 21 patients (95.5%), radius – 1 patient (4.5%). Treatment methods were various: 7 patients (31.8%) – Depomedrol injections, 4 patients (18.1%) – marrow injections, 4 patients (18.1%) – marrow and Depomedrol injections, 5 patients (22.7%) – injections with additional bone gra›s, 3 patients (13.6%) – only bone gra›s. Conclusions Simple bone cyst occurs generally in young people (under twenty). The most common problem is a pathological fracture. Treatment is long and multistage.

RETROSPECTIVE ANALYSIS OF PATIENTS WITH SIMPLE BONE CYST

Introduction Simple bone cyst is benign fluid-filled lesion localized mainly in long bones. It is usually diagnosed in the first two decades, the most common in proximal humerus. Unicameral bone cyst is often asymptomatic but can cause pathological fracture. Aim of the study The aim of our study was to evaluate clinical, diagnostic and treatment factors concerning patients with simple bone cyst. Material and methods The retrospective analysis was performed on 22 patients treated in Department of Traumatology, Orthopaedics and Hand Surgery in Poznań between 2001 and 2017. We have analyzed epidemiological factors: age and sex; symptoms; clinical examination: range of motion, presence of pain; X-ray: localisation, cyst index of Kaelin and MacEwan and presence of pathological fractures; treatment: methods, number of hospitalizations and effectiveness. Results Mean age of patients was 10.8. From 22 patients 11 were females. Generally bone cyst was diagnosed because of pathological fracture – 18 patients (85.7%). Other reasons of X-ray diagnostic were: pain – 2 patients (9.1%), deformity – 1 patient (4.5%), incidentally – 2 patients (9.1%). The bone cyst was localized in humerus – 21 patients (95.5%), radius – 1 patient (4.5%). Treatment methods were various: 7 patients (31.8%) – Depomedrol injections, 4 patients (18.1%) – marrow injections, 4 patients (18.1%) – marrow and Depomedrol injections, 5 patients (22.7%) – injections with additional bone grafts, 3 patients (13.6%) – only bone grafts. Conclusions Simple bone cyst occurs generally in young people (under twenty). The most common problem is a pathological fracture. Treatment is long and multistage

Symptomatic anterior cruciate ligament tears treated with percutaneous injection of autologous bone marrow concentrate and platelet products: a non-controlled registry study

BackgroundBone marrow concentrate (BMC) has shown promise in the treatment of several orthopedic conditions. This registry study investigated the use of autologous BMC and platelet products for percutaneous anterior cruciate ligament (ACL) treatment.MethodsTwenty-nine patients presenting to a single outpatient interventional musculoskeletal and pain practice with symptomatic grade 1, 2, or 3 ACL tears with less than 1 cm retraction were enrolled. Patients were treated with a percutaneous ACL injection of autologous BMC and platelet products using fluoroscopic guidance. Pre- and post-treatment magnetic resonance imaging analysis was completed for 23 patients using ImageJ software for an objective quantitative analysis of pixel density as a proxy for ACL integrity. Subjective clinical outcome measures collected pre-treatment and at 1, 3, 6, 12, 18, 24, and 36 months post-treatment include the Numerical Pain Scale (NPS), the Lower Extremity Functional Scale (LEFS), the International Knee Documentation Committee (IKDC) form, and a modified version of the Single Assessment Numeric Evaluation.ResultsSeventy-seven percent of patients treated with BMC injections into the ACL showed significant improvement (p < 0.01) in objective measures of ACL integrity at an average of 8.8 months (median 4.7 months). The mean of last patient-reported improvement was 72% (SD = 35) at an average of 23 (SD = 10) months post-treatment. Mean scores were found to be significantly different (p < 0.05) for the NPS at 6, 18, and 24 months, and LEFS and IKDC at all time points (i.e. 1, 3, 6, 12, 18, 24, and 36 months) relative to baseline.ConclusionIn symptomatic patients with grade 1, 2, or even grade 3 tears with minimal retraction, ACL treatment with percutaneous injection of BMC and platelet products shows promise as a non-surgical alternative. However, a larger randomized controlled trial is warranted to confirm these findings.Trial registration NCT03011398. A Clinical Registry of Orthobiologics Procedures. https://clinicaltrials.gov/ct2/show/NCT03011398?term=orthobiologics&rank=1. Registered 29 December 2016. Enrollment 1 December 2011-retrospectively registered

Стимуляция аутогенным костным мозгом остеорепарации в зоне смоделированного ложного сустава бедренной кости у крыс

Purpose To study the morphological features of bone regeneration by using a local injection of autologous red bone marrow in the conditions of an experimentally produced pseudarthrosis. Materials and methods The study was conducted on thirty (30) white laboratory rats that were bred at the Sitenko Institute for Spine and Joint Pathology of the Ukraine National Academy of Medical Sciences (6 months old, weight of 250-270 g). The experiment was conducted according to the international rules of experimental animals protection. The protocol of the experimental studies was approved by the ethics board of the Sitenko Institute for Spine and Joint Pathology of the National Academy of Medical Sciences of Ukraine. Results Culturing of mesenchymal stromal cells requires high-tech laboratory equipment and takes a long period of time. Therefore, their widespread clinical use is limited. Native bone marrow that contains mesenchymal stromal cells is easily available. The process of its preparation and transplantation is not technologically difficult. Therefore, it has advantages for being used for stimulation of reparative osteogenesis in bone fractures or in disorders of reparative osteogenesis. Conclusion The study found that autologous red bone marrow stimulated bone tissue development in the zone of pseudarthrosis. The area of bone tissue was 22.8 % larger as compared with the bone area in the untreated animals. There were no pseudarthrosis-related cavities in the regenerate structure in the cases of red bone marrow injection into the zone of traumatic injury. The features of reparative process were the following: angiogenesis activation, enchondral ossification accompanied by cancellous bone tissue formation with a network of bone trabeculae, and decrease in the destructive manifestations in the maternal bone parts located above and below the injury area.

A comparison of intraportal islet transplantation outcome between intraportal and intravenous injection of bone marrow derived spheroids

A comparison of intraportal islet transplantation outcome between intraportal and intravenous injection of bone marrow derived spheroids

Percutaneous Lumbar Intradiscal Injection of Autologous Bone Marrow Concentrated Cells Significantly Reduces Discogenic Pain through 24 Months

Percutaneous Lumbar Intradiscal Injection of Autologous Bone Marrow Concentrated Cells Significantly Reduces Discogenic Pain through 24 Months

TCT-149 Intracoronary injection of bone marrow derived mononuclear cells, early or late after acute myocardial infarction: Long-term effects on global left ventricular function - Twelve months MRI and long-term clinical results of the SWISS-AMI trial

Intracoronary administration of autologous bone marrow derived mononuclear cells (BM-MNC) may improve remodeling of the left ventricle (LV) after acute myocardial infarction (AMI) as shown by some, but not all clinical trials published so far. Long-term durability of the treatment effect is less

Ewing Sarcoma After Treatment of a Unicameral Bone Cyst of the Proximal Part of the Humerus.

Unicameral bone cysts (UBCs) were first described by Virchow in 18761. They are commonly found in the proximal part of the humerus in males between eleven and twenty years of age2,3. While some cysts are discovered incidentally after radiographs are taken for other reasons, most patients present with arm pain, with or without fracture through the cyst2. In clinical situations consistent with UBC of the proximal part of the humerus, radiographs are sufficient for diagnosis, and additional imaging usually is not recommended4. The patient and his parents were informed that data concerning the case would be submitted for publication, and they provided consent. A nine-year-old boy had experienced left shoulder pain after playing football. Because the pain had persisted, his primary care provider had obtained a radiograph; this radiograph had demonstrated a cystic lesion of the proximal part of the left humerus without fracture (Fig. 1). Subsequent magnetic resonance imaging (MRI) had been consistent with a benign bone cyst, which was likely a UBC (Fig. 2), without an associated soft-tissue mass. He had been referred to an orthopaedic oncology surgeon for management, and he had been followed for six months as the pain resolved. Fig. 1 At presentation, the anteroposterior radiograph was consistent with a UBC. Coronal short tau inversion recovery ( Fig. 2-A ), coronal T1-weighted ( Fig. 2-B ), coronal T2-weighted ( Fig. 2-C ), and sagittal T2-weighted ( Fig. 2-D ) MRI at presentation did not show a soft-tissue mass. Fig. 2-A Fig. 2-B Fig. 2-C Fig. 2-D Twelve months after the original presentation, the arm pain had returned. After repeat radiographs had confirmed an unchanged benign bone cyst, surgical aspiration and injection of autograft bone marrow and demineralized allograft bone matrix had been performed. At the time of contrast dye injection into the cyst, intraoperative fluoroscopy had not shown a noteworthy soft-tissue mass, thus confirming the diagnosis of UBC (Fig. 3). Fig. 3 Intraoperative fluoroscopic image of the humerus. Twelve months after the injection, follow-up radiographs had shown healing of the cyst. The patient …

Osteoinduction using autologous bone marrow in difficult orthopaedic problems - A clinical study

Background: Bone injury/insult heals by new bone formation a process termed as osteogenesis. When this regenerative process is deficient; healing is disturbed and need for osteoinduction arises. Various methods of osteoinduction in current practice are either extensive or expensive. Bone marrow as a natural source for osteoinduction was first described in the year 1869. Recently there are studies showing the successful osteogenesis using components of bone marrow in specific conditions. The current study aims at evaluating the results of injection of bone marrow aspirate in its natural form without separating its contents, to induce osteogenesis in difficult orthopaedic problems. Methods: The procedure was carried out in the Operation theatre under sterile precautions. Bone marrow was aspirated from the iliac crest in all cases. A sternal puncture needle was used for aspiration and around 30 ml was injected immediately, directly into the fracture site on a previously placed needle with the help of image intensifier. All these fractures had a fixation device either externally or internally. There was no evidence of infection at the time of injection. Defective non unions were excluded from the study. Radiological assessment for union was done at an interval of 4 to 6 weeks. Number of injections given varied from 2 to 4 and interval between the injections varied from 4 to 6 weeks. Results: In a total number of 33 cases distributed as follows that is, 27 type 3 B, open tibial diaphyseal fractures with delayed union stabilized by external fixator, 1 closed tibial fracture with nonunion, 1 closed tibial fracture with implant failure, 2 humeral shaft fractures with plate osteosynthesis, 2 fracture shaft femur with internal fixation, all showed progressive callus and union within an average period of 12 to 18 weeks with 2 or 4 bone marrow injections. Conclusion: We conclude that autologous bone marrow aspirate injection in its natural form is biological, simple, cost effective and reliable procedure, which can be used to induce osteogenesis in difficult orthopaedic problems without the need for any sophisticated technique or set up and gives good results. Level of the study: Prognostic Studies Level IV- See Instructions to Authors for a complete description of levels of evidence

Authors' Reply

Purpose. To evaluate 12 patients with delayed or nonunion of bones treated with bone marrow injections. Methods. 6 men and 6 women aged 15 to 70 (mean, 45) years underwent bone marrow injections for delayed union (n=2) or atrophic non-union (n=10) of the ulna (n=6), femur (n=3), humerus (n=2), or metacarpal (n=1). Bone marrow was aspirated from the anterior iliac crest and injected to the delayed and non-union sites. Two injections were given for children and adolescents, and 3 for adults. The interval between the injections was 6 to 8 weeks. The amount of bone marrow injected was 30 to 40 ml for long bones and 20 ml for metacarpals. Results. Ten of the 12 delayed or non-union of bones healed after bone marrow injections. The mean time for callus formation was 5.8 (range, 3–10) weeks, for clinical union was 7 (range, 4–12) weeks, and for radiological union was 16 (range, 10–24) weeks. Conclusion. Multiple injections of low-volume bone marrow can be used for treatment of delayed or non-union of bones.

Novel repair technique for articular cartilage defect using a fibrin and hyaluronic acid mixture

We evaluated the cartilage repair potential of a hyaluronic acid and fibrin mixture when transplanted into cartilage defects. Circular, articular, cartilage defects 4-mm in diameter were made in the trochlear region in 21 New Zealand white rabbits divided into three groups. The seven rabbits in the control group underwent microfracture (M group), the seven rabbits in the experimental group underwent microfracture with subsequent injection of hyaluronic acid mixed with fibrin (MH group), and seven rabbits in the other experimental group underwent microfracture followed by injection of bone marrow concentrate and hyaluronic acid mixed with fibrin (MBH group). At week 12 following surgery, the cartilage was observed and histologically compared in the three groups. The surface of the newly generated cartilage was very smooth and even, and we noticed that the entire area was completely regenerated in both experimental groups. The control group showed incomplete and irregular cartilage formation in the defect. In histologic scoring, comparison of the MBH group (M= 2.333) and the M group (M= 9.000) differed significantly (P= 0.046). Therefore, injection of a mixture of bone marrow concentrate, hyaluronic acid and fibrin to treat articular cartilage defects of the knee appears to be an effective method of cartilage regeneration.

TCT-495 Percutaneous, trans-endocardial injection of bone marrow derived mononuclear cells significantly improves left ventricular ejection fraction in patients following acute myocardial infarction: ALSTER Stem cell trial

Patients with large myocardial infarcts (MI) suffer from left ventricular (LV) remodeling irrespective of successful revascularization; this process may be prevented by cardiac stem cell therapy. Intracoronary application of mononuclear cells derived from bone marrow (BMC) is safe but not

A Randomized Clinical Trial Comparing Intralesional Bone Marrow and Steroid Injections for Simple Bone Cysts

A Randomized Clinical Trial Comparing Intralesional Bone Marrow and Steroid Injections for Simple Bone Cysts

Electrophysiological effects after intramyocardial injection of mesenchymal vs. mononuclear bone marrow derived stem cells in the chronic ischaemic myocardium

Electrophysiological effects after intramyocardial injection of mesenchymal vs. mononuclear bone marrow derived stem cells in the chronic ischaemic myocardium

Bone Marrow Transplantation and Autogenic Cancellous Bone Grafting in Healing of Segmental Radial Defects: An Animal Study

Emami M.J., Oryan, A., Meimandi-Parizi, A.M., Kasraee, R., Tanideh, N. and Mehrabani, D. 2006. Bone marrow transplantation and autogenic cancellous bone grafting in healing of segmental radial defects: an animal study. J. Appl. Anim. Res., 30: 69–72. To compare the healing effect of bone marrow (BM) injection with the effects of autogenic cancellous bone graft (ABG), eighteen female and male New Zealand White rabbits (1 year, 2 kg) were randomly divided into three equal groups and osteotomy and extraction of a 5 mm piece of bone was done in the mid-portion of the right radius of all rabbits. In group A, 2 ml of BM was injected in the proximal femur for five consecutive days. Group B received autogenic cancellous bone graft from ileum and group C was the control group and received no intervention. After 45 days, in group A, 83% and 17% of rabbits showed good and medium healings, respectively, while in group B, 40% showed good and 60% medium healings. In control group, medium healing was 17% and poor healing was 83%. The mean healing score was significantly higher in BM injection group, compared with B and C groups (17.1, 15.2 and 6, respectively; P<0.05). BM injection could increase the quality of healing and was much more effective than bone grafting.

Treatment of Simple Bone Cysts with Percutaneous Injection of Autogenous Bone Marrow with Crushed Cancellous Allograft

Purpose : This study evaluated the feasibility and efficacy of a percutaneous injection of a mixture of autogenous bone marrow and crushed cancellous bone allografts for the treatment of simple bone cysts. Materials and Methods : Fifteen patients with a simple bone cyst were enrolled in this study. The mean age was 13.5 years (range, 4-32 years), and the mean follow-up period was 13.2 months (range, 8-19 months). The radiographic signs of the resolution of the cyst were categorized as healed, healed with a defect, persistent and recurrent. The groups of healed and healed with a defect were designated the positive response groups. Results : Fourteen patients responded to the treatment. Nine patients showed complete healing that was first seen radiographically at 3 months (range, 1-6 months). Five patients showed healing with a defect, but no patient required a second injection because the cysts were small and did not cause functional pain. There was no correlation between clinical responses and age, gender, location, cyst index and previous treatment modalities. One patient had a pathological fracture, which was treated successfully by open bone grafting with flexible intramedullary nailing. Conclusion : A percutaneous injection of a mixture of autogenous bone marrow and a crushed cancellous bone allograft may be an effective treatment for simple bone cysts.