Use Of Bone Marrow Aspirate Research Articles

Stem Cell Therapy in Cartilage Repair—Culture-Free and Cell Culture–Based Methods

In order to overcome potential problems associated with autologous chondrocyte implantation, mesenchymal stem cell-based therapies could be potential alternatives. Conventional stem cell-based therapy accompanies the separation of cells from tissue followed by monolayer culture for the expansion of cell numbers. On the other hand, the cost of cell culture under quality control is high, which could be a potential barrier for industrialization. In order to reduce the cost associated cell culture, culture-free cell-based therapies have been investigated with the use of bone marrow aspirate. In this chapter, we will introduce the three stem cell-based therapies in cartilage repair. The first two procedures are using cell culture methods and the last one with cell-free method. All the three methods have been into the stage of clinical trials and their surgical procedures as well as their preliminary results will be reported.

Cell Based Therapies as Compared to Autologous Bone Grafts for Spinal Arthrodesis

Systematic review. To compare the clinical outcome of cell based grafts combined with bone extenders to autologous bone grafts. Alternative graft options that combine mesenchymal stem cells (MSCs) and bone marrow aspirate (BMA) with synthetic or allograft scaffolds have been recently used in several animal and clinical studies. This systematic review of the literature addresses the following key questions (KQs): (1) Does the use of MSCs or BMA combined with synthetic or allograft extenders contribute to thoracolumbar fusion rates that are comparable with the rates achieved by the use of iliac crest graft? (2) Are these fusion rates comparable with those of local bone graft (LBG)? (3) Does the addition of MSCs or BMA to iliac crest bone graft or LBG contribute to better throracolumbar fusion rates? (4) Are the cervical spine fusion outcomes achieved by the use of SCM or BMA with synthetic or allograft scaffolds comparable with the iliac crest bone graft or LBG outcomes? (5) Was there any difference in terms of fusion rates, when MSCs were compared with BMA? For KQ1, 4 level II, III studies used iliac crest bone graft as control. The results of these studies were inconsistent, and the overall body of evidence was found insufficient. Three, level II, III studies were identified for KQ2. Comparable fusion rates were demonstrated between LBG and BMA combined with calcium phosphate or collagen carrier. The overall body of evidence was found weak. For KQ3, one level III study was found. No significant difference was found in the fusion rates. No studies met the criteria for KQ4, 5. The currently available evidence is insufficient to support the use of MSCs or BMA combined with synthetic or allograft materials as a substitute or supplementary graft to autologous bone graft. 2.

Bone Marrow Aspirate Concentrate Used with Bovine Bone Mineral to Reconstruct Vertical and Horizontal Mandibular Defects: Report of Two Techniques

Following initial positive reports of the use of bone marrow aspirate concentrate (BMAC) in combination with bovine bone mineral (BBM) in augmentation procedures, the technique was evaluated in patients with mandibular deficiency. Two adult patients required surgical correction of a deficient alveolar ridge (one patient showed horizontal deficiency only, and the other patient presented with horizontal and vertical deficiency) prior to dental implant placement. In both patients, the reconstruction was performed with BBM in combination with mononuclear cells concentrated by the BMAC method using different techniques. The patients recovered well from all surgical procedures. Histologically, there was uniform bone formation, which allowed placement of dental implants. The results suggest that the use of BMAC in combination with BBM, without autogenous bone, has the potential to restore horizontal and vertical mandibular alveolar defects, providing a functional bone structure and allowing dental implant placement for subsequent prosthetic rehabilitation.

The Use of Bone Marrow Aspirate Concentrated for Full-thickness Knee Cartilage Lesions in a One-step Procedure: A Prospective Study (SS-25)

Introduction The purpose of our study was to determine the effectiveness of cartilage repair utilizing one-step surgery with autologous bone marrow aspirate concentrate (BMAC) and a collagen I/III matrix. Methods We prospectively followed-up 25 patients (mean age 46 years) operated for grade IV cartilage lesions of the knee, for an average of 2 years. All patients underwent a mini-arthrotomy and concomitant transplantation with BMAC covered with the collagen matrix (Chondro-Gide; Geistlich, Wolhusen, Switzerland). Bone marrow was harvested from ipsilateral iliac crest and subjected to concentration and activation with Batroxobin solution (Plateltex; act-Plateltex SRO, Bratislava, Slovakia). Co-existing pathologies were treated before or during the same surgery. All patients followed the same specific rehabilitation program for a minimum of 6 months. Ten patients had multiple chondral lesions and the average lesion size was 8.3 cm2. X-rays and MRI were collected preoperatively, at 1 year, and at final follow-up. VAS, IKDC, KOOS, Lysholm, Marx, SF36, and Tegner scores were collected preoperatively, at 6-12 months, and final follow-up; nonparametric analysis was performed with the Wilcoxon rank test to compare these variations. Six patients gave their consent for second-look arthroscopy and 5 of them for a concomitant biopsy. Results Patients showed significant improvement in all scores at final follow-up (p < .005). Mean preoperative values were: VAS 5.2, IKDC subjective 43.6, KOOS Scores P=66.2/ S=68.2/ ADL=70.0/ SP=41.6/ QOL=37.2, Lysholm 60.4, Marx 4.2, SF36 (P/M) 40.4/ 51.5 and Tegner 2.0. At final follow-up, mean scores were: VAS 0.7, IKDC subjective 80.7, KOOS P=94.0/ S=90.1/ ADL=95.1/ SP=71.3/ QOL=77.5, Lysholm 92.9, Marx 10.3, SF36 (P/M) 55.5/54.0 and Tegner 4.9. MRI showed good coverage of the lesion and tissue quality in all patients in accordance with clinical results. Good histologic findings were reported for all the specimens analyzed that presented hyaline-like features. No adverse reactions or postoperative complications were noted. Conclusion This study showed that the use of autologous bone marrow derived and collagen I/III matrix in a one-step procedure could represent an improvement on the currently available techniques for cartilage transplantation could be a viable technique in the treatment of grade IV knee chondral lesions. The purpose of our study was to determine the effectiveness of cartilage repair utilizing one-step surgery with autologous bone marrow aspirate concentrate (BMAC) and a collagen I/III matrix. We prospectively followed-up 25 patients (mean age 46 years) operated for grade IV cartilage lesions of the knee, for an average of 2 years. All patients underwent a mini-arthrotomy and concomitant transplantation with BMAC covered with the collagen matrix (Chondro-Gide; Geistlich, Wolhusen, Switzerland). Bone marrow was harvested from ipsilateral iliac crest and subjected to concentration and activation with Batroxobin solution (Plateltex; act-Plateltex SRO, Bratislava, Slovakia). Co-existing pathologies were treated before or during the same surgery. All patients followed the same specific rehabilitation program for a minimum of 6 months. Ten patients had multiple chondral lesions and the average lesion size was 8.3 cm2. X-rays and MRI were collected preoperatively, at 1 year, and at final follow-up. VAS, IKDC, KOOS, Lysholm, Marx, SF36, and Tegner scores were collected preoperatively, at 6-12 months, and final follow-up; nonparametric analysis was performed with the Wilcoxon rank test to compare these variations. Six patients gave their consent for second-look arthroscopy and 5 of them for a concomitant biopsy. Patients showed significant improvement in all scores at final follow-up (p < .005). Mean preoperative values were: VAS 5.2, IKDC subjective 43.6, KOOS Scores P=66.2/ S=68.2/ ADL=70.0/ SP=41.6/ QOL=37.2, Lysholm 60.4, Marx 4.2, SF36 (P/M) 40.4/ 51.5 and Tegner 2.0. At final follow-up, mean scores were: VAS 0.7, IKDC subjective 80.7, KOOS P=94.0/ S=90.1/ ADL=95.1/ SP=71.3/ QOL=77.5, Lysholm 92.9, Marx 10.3, SF36 (P/M) 55.5/54.0 and Tegner 4.9. MRI showed good coverage of the lesion and tissue quality in all patients in accordance with clinical results. Good histologic findings were reported for all the specimens analyzed that presented hyaline-like features. No adverse reactions or postoperative complications were noted. This study showed that the use of autologous bone marrow derived and collagen I/III matrix in a one-step procedure could represent an improvement on the currently available techniques for cartilage transplantation could be a viable technique in the treatment of grade IV knee chondral lesions.

Bone Marrow Aspirate Concentrate and Platelet-rich Plasma as Biological Adjuncts to the Surgical Treatment of Osteochondral Lesions of the Talus

Symptomatic osteochondral lesions of the talus can be debilitating injuries in both the general and athletic populations, where surgical treatment is often required to provide functional pain relief and return to play in athletes. The most common surgical treatment strategies include reparative (ie, microfracture and drilling) and restorative techniques. Reparative techniques allow fibrocartilage differentiation to fill the defect site and thereby protect the subchondral bone. The concern with the mechanically and biologically inferior fibrocartilage is that it may ultimately degrade over time, particular in larger lesions. Restorative techniques (ie, autologous osteochondral transplantation) provide a potential advantage over reparative techniques in that “like with like” in terms of hyaline cartilage at the site of cartilage repair and may afford the joint increased longevity over time. The current authors' have developed a treatment strategy by which the treatment strategy is based on lesion size. Lesions less than or equal to 8 mm in diameter are treated with microfracture whereas lesions greater than 8 mm in size are treated with autologous osteochondral transplantation. The current authors' are also investigating the use of bone marrow aspirate concentrate and platelet-rich plasma as a potential means of improving fibrocartilage and bone healing. This article will describe the potential uses of bone marrow aspirate concentrate and platelet-rich plasma in the surgical treatment of osteochondral lesions of the talus.

Bone Marrow Aspirate Concentrate (BMAC) as a Biological Adjunct to the Surgical Treatment of Osteochondral Lesions of the Talus

Osteochondral lesions of the talus are common injuries, particularly in athletes. Traditional surgical treatment paradigms for osteochondral lesions include reparative and restorative techniques. The concern with reparative techniques (ie, microfracture and drilling) is that the fibrocartilaginous infill may ultimately fail over time, thereby causing recurrence in symptoms and a progression of arthritis. The current authors have developed a treatment algorithm whereby reparative techniques are reserved for lesions ≤8 mm in diameter, beyond which replacement strategies (ie, autologous osteochondral plug transplantation) comprise the preferred treatment strategy. In an effort to address the concerns of fibrocartilage degradation over time, the authors are currently studying the use of bone marrow aspirate concentrate (BMAC) as a means of improving the tissue quality and collagen fiber architecture of the differentiated repair cartilage. When used as an adjunct to the autologous osteochondral plug transplantation procedure, BMAC may facilitate infill of the graft-host bone and cartilage, thereby reducing the theoretical potential of synovial fluid inflow under normal joint hydrostatics, which could undermine the graft over an extended period. This article will evaluate the use of BMAC in the surgical treatment of osteochondral lesions of the talus.

Clinical and radiographic assessment of transforaminal lumbar interbody fusion using HEALOS collagen-hydroxyapatite sponge with autologous bone marrow aspirate

Background context Studies have suggested that the use of bone marrow aspirate (BMA) with HEALOS (DePuy Spine, Raynham, MA), a collagen-hydroxyapatite sponge (CHS), is an effective substitute for autologous iliac crest bone graft when used in fusion procedures of the lumbar spine. Purpose To assess clinical and radiographic outcomes after implantation of BMA/CHS in patients undergoing transforaminal lumbar interbody fusion (TLIF) with posterolateral fusion (PLF). Study design/setting Case series radiographic outcome study. Patient sample Twenty patients. Outcome measures Radiographs/computed tomography (CT) scans. Methods From September 2003 to October 2004, 20 patients (22 interbody levels) were implanted with BMA/CHS via TLIF/PLF with interbody cages and posterior pedicle screws. All patients were retrospectively identified and invited for a 2-year prospective follow-up. Plain radiographs with dynamic films and CT scans were taken, and fusion was assessed in a blinded manner. Results Follow-up averaged 27 months (range: 24–29). Primary diagnosis included spondylolisthesis (17 patients), scoliosis with asymmetric collapse (2 patients), and postdiscectomy foraminal stenosis (1 patient). The overall fusion rate was 95% (21/22 levels, 19/20 patients). Anteriorly bridging bone was observed in 91% of the anteriorly fused levels (20/22), of which 65% (13/20) occurred through and around the cage and 35% (7/20) around the cage only. Unilateral or bilateral bridging of the posterior fusion masses was observed in 91% (20/22), with 55% occurring bilaterally (12/22). In 4 (18%) cases, bridging only occurred either posteriorly (2 cases) or anteriorly (2 cases). Complications included one deep wound infection. Conclusions At the 2-year follow-up, BMA/CHS showed acceptable fusion rates in patients undergoing TLIF/PLF, and can be considered as an alternative source of graft material.