Bone Marrow Aspirate Concentrate and Platelet-rich Plasma Enhanced Bone Healing in Distraction Osteogenesis of the Tibia

Abstract

Background During lower limb lengthening, poor bone regeneration is a devastating complication. Several local or systemic applications have been used to promote osteogenesis, and biologic stimulations are gaining attention, but their utility has not been proven in this setting. Questions/purposes In patients undergoing bilateral tibial lengthening, we compared those receiving an osteotomy site injection of autologous bone marrow aspirate concentrate (BMAC) plus platelet-rich plasma (PRP) with those not receiving such an injection in terms of external fixator index (time in external fixation divided by amount of lengthening), full weightbearing index (time until a patient was permitted to do full weightbearing divided by amount of lengthening), four cortical healing indexes (time until each cortical union divided by amount of lengthening), and callus shape and type. Methods Twenty-two patients (44 tibias) undergoing bilateral tibial lengthening enrolled in this randomized trial. Two patients were excluded, one due to insufficient radiographic evaluation and one who was lost to followup, leaving 20 patients (40 segments) for inclusion. Ten patients (20 segments) received BMAC combined with PRP injection (treatment group) and 10 patients (20 segments) received no injection (control group). All patients underwent stature lengthening for familial short stature with the lengthening over nail technique. Autologous BMAC combined with PRP was injected at the tibial osteotomy site at the end of the index surgery. Mean distraction rates were similar between groups (0.75 mm/day in the treatment group versus 0.72 mm/day in the control group; p = 0.24). Full weightbearing was permitted when we observed radiographic evidence of healing at two cortices; this assessment was made by the surgeon who was blinded to the treatment each patient received. Minimum followup was 24 months (mean, 28 months; range, 24-34 months).

Advancing biomaterials of human origin for tissue engineering

“…, by vacuum aspiration) from the iliac crest to facilitate the availability of autologous bone marrow and the establishment of a standardized dose of stromal cells and mononuclear cells in a well-prepared BMC product [560]. For many years, it has been recognized that BMC may possess high potency in cartilage and osseous defect healing when used in combination with grafting materials and occasionally PRP [561–565]. However, there are no published randomized controlled trials on the efficacy of autologous BMC intra-articular injections performed as a same-day, in-office procedure for treating patients with cartilage or bone disease [566].…”

Is there a treatment protocol in which platelet-rich plasma is effective?

“…[37][38][39][40] When the studies in which PRP was obtained from autologous blood in clinics were considered, it was found that it was prepared from 10 to 20 min. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] Nevertheless, it takes time to apply it to cases, which makes its bioactive and effective treatment results controversy.…”

“…8 However, as there are contradictory results reported in some cases in literature where PRP was applied, there are some questions regarding the efficiency of PRP treatment. [16][17][18] Some manuscripts indicated that PRPs with different contents are superior in clinical treatment. 19 There was no well-proven study in which PLT and leucocyte (WBC) rates were separately discussed in PLT concentrations in PRP content.…”

What’s New in Limb Lengthening and Deformity Correction

“…The clinical importance of these findings remains questionable 121 . A randomized study revealed a 27% reduction in external fixation time with the use of low-intensity pulsed ultrasound for tibial osteoplasty 122 .…”