Effects of Autogenous Bone Marrow Aspirate Concentrate on Radiographic Integration of Femoral Condylar Osteochondral Allografts

2017 ◽  
Vol 45 (12) ◽  
pp. 2797-2803 ◽  
Author(s):  
Lasun O. Oladeji ◽  
James P. Stannard ◽  
Cristi R. Cook ◽  
Mauricio Kfuri ◽  
Brett D. Crist ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Aspirate ◽  
Autogenous Bone ◽  
Level Of Evidence ◽  
Bone Marrow Aspirate Concentrate ◽  
Significant Difference ◽  
Bone Integration ◽  
Articular Cartilage Lesions ◽  
Time Point ◽  
Osteochondral Allografts

Background: Transplantation of fresh osteochondral allografts (OCAs) is an attractive treatment option for symptomatic articular cartilage lesions in young, healthy patients. Because the lack of OCA bone integration can be a cause of treatment failure, methods for speeding and enhancing OCA bone integration to mitigate this potential complication are highly desirable. Purpose: To determine if autogenous bone marrow aspirate concentrate (BMC) treatment of large femoral condylar OCAs would be associated with superior radiographic OCA bone integration compared with nontreated allografts during the critical first 6 months after surgery. Study Design: Cohort study; Level of evidence, 3. Methods: A review of patients enrolled in a prospective registry who were treated with transplantation of large OCAs to one or both femoral condyles at our institution from March 12, 2013 to March 14, 2016 was performed. Patients were stratified into 2 groups based on BMC treatment versus no BMC treatment; the treatment was nonrandomized and was rooted in a shift in practice and a continuing effort to optimize OCA transplantation at our institution. Patients were excluded if they did not have orthogonal view radiographs performed at 6 weeks, 3 months, and 6 months postoperatively. Each condyle undergoing OCA transplantation was assessed individually by an independent musculoskeletal radiologist, who was blinded to the treatment group and time point. OCAs were assessed with respect to graft integration (0%-100%; 0 = no integration, 100 = complete integration) and degree of sclerosis (0-3; 0 = normal, 1 = mild sclerosis, 2 = moderate sclerosis, and 3 = severe sclerosis) of the graft at each time point. Results: This study identified 17 condyles in 15 patients who underwent OCA transplantation without BMC and 29 condyles in 22 patients who underwent OCA transplantation with BMC. The BMC group had significantly ( P = .033) higher graft integration scores at 6 weeks, 3 months, and 6 months after surgery. Graft sclerosis was significantly ( P = .017) less in the BMC group at 6 weeks and 3 months, with no significant difference at 6 months after surgery. When combining the groups to examine the influence of smoking on graft integration, nonsmokers had significantly ( P = .007) higher graft integration scores at 6 months. Conclusion: Large femoral condylar OCAs treated with autogenous BMC before implantation showed superior radiographic integration to bone and less sclerosis during the initial 6-month postoperative period. BMC treatment of OCAs may mitigate the failure of OCA bone healing.

scholarly journals COMPARISON BETWEEN CONCENTRATED BONE MARROW ASPIRATE AND CORTICOID IN GLUTEAL TENDINOPATHY

2021 ◽  
Vol 29 (1) ◽  
pp. 26-29
Author(s):  
DAVI ARAÚJO VEIGA ROSÁRIO ◽  
THIAGO BATISTA FALEIRO ◽  
BRUNO ADELMO FERREIRA MENDES FRANCO ◽  
GILDÁSIO DE CERQUEIRA DALTRO ◽  
REINALDO MARCHETTO
Keyword(s):  
Clinical Trial ◽  
Bone Marrow ◽  
Randomized Clinical Trial ◽  
Standard Treatment ◽  
Bone Marrow Aspirate ◽  
University Hospital ◽  
Level Of Evidence ◽  
Bone Marrow Aspirate Concentrate ◽  
Gluteal Tendinopathy ◽  
Significant Difference

ABSTRACT Objective: To compare bone marrow aspirate concentrate (BMAC) with the standard treatment for gluteal tendinopathies. Methods: 48 patients diagnosed with gluteal tendinopathy at a university hospital were selected by a randomized clinical trial and divided into two groups: (G1) bone marrow aspirate concentrate and (G2) corticosteroid injections. Results: 40 of the 48 selected patients were monitored for six months and both groups showed better scores. Visual analog scale (VAS) scores and Lequesne index were statistically significant higher in patients submitted to BMAC treatment when compared to standard treatment. Both groups improved their quality of life, without statistically significant difference. Conclusion: BMAC constitutes an alternative to gluteal tendinopathy standard treatment, proving to be a safe technique with promising results when combined with multidisciplinary team behavioral therapy. Level of Evidence II, Randomized Clinical Trial.

scholarly journals Retroarticular Drilling with Supplemental Bone Marrow Aspirate Concentrate for the Treatment of Osteochondritis Dissecans of the Knee

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0013 ◽  
Author(s):  
Kelsey Davidson ◽  
Nathan L. Grimm ◽  
Melissa A. Christino ◽  
S. Clifton Willimon ◽  
Michael T. Busch
Keyword(s):  
Bone Marrow ◽  
Osteochondritis Dissecans ◽  
Bone Marrow Aspirate ◽  
Femoral Condyle ◽  
Lesion Size ◽  
Autogenous Bone ◽  
Bone Marrow Aspirate Concentrate ◽  
The Mean ◽  
Back Filling

Objectives: Osteochondritis dissecans (OCD) is an idiopathic alteration of the subchondral bone which may lead to early osteoarthritis. This condition is commonly seen in the knee and is more common in young, athletic individuals. Several techniques have been developed to address the variable presentation of OCD in the knee, each with varying results. To our knowledge the use of autogenous bone marrow supplementation to an OCD lesion has not been described. The purpose of this study was to determine the radiographic healing of OCD lesions of the knee in a cohort of young, active patients who underwent retroarticular drilling of an OCD lesion with supplemental back-filling with bone marrow aspirate concentrate as an adjuvant to facilitate healing. Methods: We evaluated adolescent patients who were diagnosed with OCD of the knee who had previously failed non-operative, conservative treatment. All subjects underwent retroarticular drilling of the knee with supplemental back-filling of the lesion with bone marrow aspirate concentrate (BMAC®), harvested from the ilium, by two Orthopaedic Surgeons from a single institution. Based off previously published definitions, lesions were assigned as small if < 320 mm2 or large >320 mm2. All lesions were then followed radiographically for evidence of healing. Healing was graded based off the ROCK (Research in OsteoChondritis of the Knee) group radiographic healing criteria, which has shown excellent reliability. The healing was rated by two independent reviewers and when disagreements were noted a third reviewer was brought in to facilitate group consensus on healing. Results: 52 lesions in 49 patients were included in the study. 26 right knees, 26 left knees with 41 lesions located on the medial femoral condyle and 11 lesions located on the lateral femoral condyle. The mean age of the subjects was 12.5 (10 - 17) years old. 30 subjects were male, 19 were female. All lesions were categorized as immobile lesions based off the ROCK Arthroscopy Classification. The average OCD lesion size was 407 mm2 (132 - 899 mm2), respectively. The mean amount of BMAC® used per OCD lesion was 60 mL (45 - 120 mL). 40 lesions (76.9%) were rated as healed at a mean of 10.6 (2 - 32) months. 10 lesions (18.9%) were rated as 25-75% healed and 3.8% were rated at 0 - 25% healed at latest follow-up. 76.5% of large lesions were rated as healed at final follow-up. Whereas 77.8% of small lesions were rated as healed at final follow-up. There were three complications (1 rash from skin glue, 1 suture abscess, and 1 contact dermatitis from surgical cleansing prep) however no complications were noted from the surgical intervention or BMAC®. Conclusion: Overall healing rates with surgical treatment of OCD lesions that have failed non-operative interventions are variable. For immobile lesions, mainstay treatment options include retroarticular and transarticular drilling. Based off previous definitions of lesion size, the mean lesion size in our cohort would be categorized as “large” with 65% of our lesions falling into this category. Previously published series have shown that large lesions are significantly less likely to heal. Despite this we showed a 76.5% healing rate for large lesions. Overall, the adjuvant supplementation of BMAC® as back-fill for retrograde drilling of large OCD lesions of the knee has shown excellent results with no serious complications associated with its use. Future randomized trials are necessary to evaluate the comparative effectiveness of this treatment method.

scholarly journals Effects of Bone Marrow Aspirate Concentrate on Radiographic Integration of Femoral Condylar Osteochondral Allografts

2017 ◽  
Vol 5 (7_suppl6) ◽  
pp. 2325967117S0033
Author(s):  
James P. Stannard ◽  
Lasun O. Oladeji ◽  
Cristi Cook ◽  
Mauricio Kfuri ◽  
Brett D. Crist ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Aspirate ◽  
Bone Marrow Aspirate Concentrate ◽  
Osteochondral Allografts

Bone Marrow Aspirate Concentrate versus Platelet Rich Plasma to Enhance Osseous Integration Potential for Osteochondral Allografts

2017 ◽  
Vol 31 (04) ◽  
pp. 314-320 ◽  
Author(s):  
Charles Baumann ◽  
James Stannard ◽  
James Cook ◽  
Aaron Stoker
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Aspirate ◽  
Platelet Rich Plasma ◽  
Fluorescent Microscopy ◽  
Negative Control ◽  
Osteochondral Allograft ◽  
Bone Marrow Aspirate Concentrate ◽  
A Cell ◽  
The Media ◽  
Bone Integration

AbstractFresh osteochondral allograft (OCA) transplantation is an attractive treatment option for symptomatic articular cartilage lesions in young, healthy patients. Since a lack of OCA bone integration can be a cause of treatment failure, methods for speeding and enhancing OCA bone integration to mitigate this potential complication are highly desirable. This study sought to determine and compare the potential of bone marrow aspirate concentrate (BMC) and leukoreduced platelet rich plasma (PRP) to repopulate the osseous portion of an OCA with cells and deliver osteogenic proteins. It was hypothesized that BMC would have significantly higher colony forming units (CFUs)/mL and seed the osseous portion of OCA with more cells than PRP. Finally, we hypothesized that the media of BMC and PRP treated OCAs would have significantly higher concentrations of osteogenic proteins compared with negative control OCAs. Cylindrical OCAs (n = 36) created from tissue stored for 21 days were treated with BMC (n = 12) or PRP (n = 12) obtained for 6 dogs, or left untreated as a negative control (n = 12). After treatment, OCAs were cultured for 7 or 14 days. Media were collected for analysis of osteogenic biomarker concentration. Samples of each BMC and PRP were tested for CFU concentration. On day 7 or 14, the grafts were assessed for cell surface adhesion and penetration using fluorescent microscopy. Significant differences in CFU and media biomarker concentration between the groups were determined using one-way analysis of variance (ANOVA) and Tukey's post-hoc test with the significance set at p < 0.05. Only OCAs saturated with BMC had viable cells detectable on the osseous portion of the allografts at day 7 and 14 of culture. BMC samples had a significantly higher (p = 0.029) CFU/mL compared with PRP samples. At day 3 and/or 7 of culture, the concentration of several osteogenic proteins was significantly higher in both BMC and PRP samples. Autogenous BMC can be used to deliver both a cell population and osteogenic proteins that may improve healing of the osseous portion of the OCA clinically.

A Prospective, Single-Blind, Placebo-Controlled Trial of Bone Marrow Aspirate Concentrate for Knee Osteoarthritis

2016 ◽  
Vol 45 (1) ◽  
pp. 82-90 ◽  
Author(s):  
Shane A. Shapiro ◽  
Shari E. Kazmerchak ◽  
Michael G. Heckman ◽  
Abba C. Zubair ◽  
Mary I. O’Connor
Keyword(s):  
Bone Marrow ◽  
Pain Relief ◽  
Bone Marrow Aspirate ◽  
Controlled Trial ◽  
Joint Disease ◽  
Level Of Evidence ◽  
Serious Adverse Events ◽  
Bone Marrow Aspirate Concentrate ◽  
Early Results ◽  
Single Blind

Background: Bone marrow aspirate concentrate (BMAC) is increasingly used as a regenerative therapy for musculoskeletal pathological conditions despite limited evidence-based support. Hypothesis: BMAC will prove feasible, safe, and efficacious for the treatment of pain due to mild to moderate degenerative joint disease of the knee. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: In this prospective, single-blind, placebo-controlled trial, 25 patients with bilateral knee pain from bilateral osteoarthritis were randomized to receive BMAC into one knee and saline placebo into the other. Fifty-two milliliters of bone marrow was aspirated from the iliac crests and concentrated in an automated centrifuge. The resulting BMAC was combined with platelet-poor plasma for an injection into the arthritic knee and was compared with a saline injection into the contralateral knee, thereby utilizing each patient as his or her own control. Safety outcomes, pain relief, and function as measured by Osteoarthritis Research Society International (OARSI) measures and the visual analog scale (VAS) score were tracked initially at 1 week, 3 months, and 6 months after the procedure. Results: There were no serious adverse events from the BMAC procedure. OARSI Intermittent and Constant Osteoarthritis Pain and VAS pain scores in both knees decreased significantly from baseline at 1 week, 3 months, and 6 months ( P ≤ .019 for all). Pain relief, although dramatic, did not differ significantly between treated knees ( P > .09 for all). Conclusion: Early results show that BMAC is safe to use and is a reliable and viable cellular product. Study patients experienced a similar relief of pain in both BMAC- and saline-treated arthritic knees. Further study is required to determine the mechanisms of action, duration of efficacy, optimal frequency of treatments, and regenerative potential. Registration: ClinicalTrials.gov record 12-004459.

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

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0045
Author(s):  
Drew N. Stal ◽  
Stephanie K. Eble ◽  
Oliver B. Hansen ◽  
Bopha Chrea ◽  
Mark C. Drakos
Keyword(s):  
Bone Marrow ◽  
Outcome Measures ◽  
Fracture Fixation ◽  
Ankle Fracture ◽  
Bone Marrow Aspirate ◽  
Osteochondral Lesions ◽  
Bone Marrow Aspirate Concentrate ◽  
Significant Difference ◽  
Patient Reported

Category: Arthroscopy; Basic Sciences/Biologics; Trauma Introduction/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.

scholarly journals Functional outcomes of bone marrow aspirate concentrate application in osteoarthritis of the knee

2019 ◽  
Vol 7 (2) ◽  
pp. 587
Author(s):  
Safa Gursoy ◽  
Mustafa Akkaya ◽  
Mehmet Emin Simsek ◽  
Murat Bozkurt
Keyword(s):  
Bone Marrow ◽  
Functional Recovery ◽  
Functional Outcomes ◽  
Bone Marrow Aspirate ◽  
Osteoarthritis Of The Knee ◽  
Bone Marrow Aspirate Concentrate ◽  
Symptomatic Knee ◽  
Significant Difference ◽  
The Mean

Background: Osteoarthritis (OA) of the knee is a very common musculoskeletal disorder. Although total knee replacement is a suitable option in the treatment of severe OA, it has some limitations when performed in the early stage and early age. Bone marrow aspirate concentrate (BMAC), which is rich in mesenchymal stem cells, is promising due to its potentially regenerative and symptomatic effects in many disorders of the musculoskeletal system. This study aims to investigate the efficacy of BMAC in terms of functional recovery in OA of the knee joint.Methods: Total of 52 patients with unilateral symptomatic knee OA but no inflammatory disease, advanced malalignment or instability were enrolled in this study. Bone marrow aspirate was collected from the iliac crest in one session, prepared using a manufactured kit and the patients received intra-articular injections of this BMAC. The mean age of the patients was 59.2±7.4 and the mean follow-up period was 22.1±3.6 months. Functional outcomes of the patients were evaluated using Modified Cincinnati and Tegner Lysholm scoring systems.Results: It was observed that both Lysholm and Cincinnati scores of the patients were statistically significantly higher throughout the follow-up period as compared to the period before the procedure (p=0.0001). There was no statistically significant difference in Lysholm and Cincinnati ratings between gender, side and body mass index groups throughout the follow-up period (p >0.05). It was found that the results of the patients with Kellgren-Lawrence Grade 4 severe joint arthrosis were statistically significantly lower (p <0.05).Conclusions: Considering the functional outcomes of the patients up to two years, it was observed that the application of concentrated bone marrow aspirate provided functional recovery in arthrosis of the knee joint.

Medial Meniscus Scaffold Implantation in Combination with Concentrated Bone Marrow Aspirate Injection: Minimum 3-Year Follow-up

2020 ◽  
Vol 33 (08) ◽  
pp. 838-846 ◽  
Author(s):  
Mustafa Akkaya ◽  
Mehmet Emin Şimşek ◽  
Safa Gürsoy ◽  
Nurdan Çay ◽  
Murat Bozkurt
Keyword(s):  
Bone Marrow ◽  
Medial Meniscus ◽  
Bone Marrow Aspirate ◽  
Preoperative Period ◽  
Short Term ◽  
Level Of Evidence ◽  
Pain Scores ◽  
Significant Difference ◽  
Concentrated Bone Marrow

AbstractThe objective of this study is to show the short-term clinical and radiological outcomes of concentrated bone marrow aspirate (CBMA) injection administered in combination with medial meniscus scaffold implantation. Twenty-three patients who received intra-articular CBMA injection in combination with polyurethane-based medial meniscus scaffold implantation were evaluated within the scope of this study. The International Knee Documentation Committee (IKDC) questionnaire and the Knee injury and Osteoarthritis Outcome Score (KOOS) were used to evaluate the results, and the visual analog scale was used to assess the pain scores. Magnetic resonance imaging (MRI) scans were obtained in the preoperative period and at postoperative months 1, 12, 24, and 36 to assess the scaffold position as well as chondral degeneration/damage in a comparative manner. MRI assessment was performed by using the modified Outerbridge scale for cartilage and the Genovese scoring system for the meniscal implant. Twenty-three patients who were included in the study were evaluated for a mean follow-up period of 38.3 months. Patients exhibited statistically significant improvement according to all scoring data from the preoperative period until the follow-up period. The mean postoperative extrusion at year 3 was 2.39 mm (distribution 2.30–2.56 mm). There was no significant difference in the distribution of the degree of chondral damage between the preoperative and 3-year follow-up periods. Four patients did not show any improvement nor had lower scores according to the assessment. Medial meniscus scaffold implantation combined with intra-articular CBMA injection resulted in a significant improvement in all functions and pain scores as well as a statistically significant clinical improvement in IKDC and KOOS values in the short-term follow-up. The Level of evidence for this study is IV.

A Comparison of Outcomes of Particulated Juvenile Articular Cartilage and Bone Marrow Aspirate Concentrate for Articular Cartilage Lesions of the Talus

2016 ◽  
Vol 10 (4) ◽  
pp. 315-321 ◽  
Author(s):  
Nathan S. Lanham ◽  
John J. Carroll ◽  
Minton T. Cooper ◽  
Venkat Perumal ◽  
Joseph S. Park
Keyword(s):  
Bone Marrow ◽  
Articular Cartilage ◽  
Bone Marrow Aspirate ◽  
Short Form ◽  
Case Series ◽  
Foot And Ankle ◽  
Cartilage Lesions ◽  
Bone Marrow Aspirate Concentrate ◽  
The Mean ◽  
Articular Cartilage Lesions

Background. Articular cartilage lesions of the talus remain a challenging clinical problem because of the lack of natural regeneration and limited treatment options. Microfracture is often the first-line therapy, however lesions larger than 1.5 cm2 have been shown to not do as well with this treatment method. Methods. The objective of this retrospective study was to evaluate the outcomes of iliac crest bone marrow aspirate concentrate/collagen scaffold (ICBMA) and particulated juvenile articular cartilage (PJAC) for larger articular cartilage lesions of the talus. Fifteen patients undergoing ICBMA or PJAC for articular cartilage lesions of the talus from 2010 to 2013 were reviewed. Twelve patients, 6 from each treatment option, were included in the study. American Orthopaedic Foot and Ankle Surgeons (AOFAS), Foot and Ankle Ability Measure (FAAM), and Short Form–12 (SF-12) outcome scores were collected for each patient. Results. The mean age was 34.7 ± 14.8 years for ICBMA and 31.5 ± 7.4 years for PJAC. Lesion size was 2.0 ± 1.1 cm2 for ICBMA and 1.9 ± 0.9 cm2 for PJAC. At a mean follow-up of 25.7 months (range, 12-42 months), the mean AOFAS score was 71.33 for ICBMA and 95.83 for PJAC (  P = .019). The FAAM activities of daily living subscale mean was 77.77 for ICBMA and 97.02 for PJAC (   P = .027). The mean FAAM sports subscale was 45.14 for ICBMA and 86.31 for PJAC (  P = .054). The SF-12 physical health mean was 47.58 for ICBMA and 53.98 for PJAC (  P = .315). The SF-12 mental health mean was 53.25 for ICBMA and 57.8 for PJAC (  P = .315). One patient in treated initially with ICBMA underwent revision fixation for nonunion of their medial malleolar osteotomy, which ultimately resulted in removal of hardware and tibiotalar arthrodesis at 2 years from the index procedure. Conclusion. In the present analysis, PJAC yields better clinical outcomes at 2 years when compared with ICBMA for articular cartilage lesions of the talus that were on average greater than 1.5cm2. Levels of Evidence: Therapeutic, Level IV: Retrospective, Case series

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