Clinical application of concentrated bone marrow aspirate in orthopaedics: A systematic review

Abstract

AIMTo examine the evidence behind the use of concentrated bone marrow aspirate (cBMA) in cartilage, bone, and tendon repair; establish proof of concept for the use of cBMA in these biologic environments; and provide the level and quality of evidence substantiating the use of cBMA in the clinical setting.METHODSWe conducted a systematic review according to PRISMA guidelines. EMBASE, MEDLINE, and Web of Knowledge databases were screened for the use of cBMA in the repair of cartilage, bone, and tendon repair. We extracted data on tissue type, cBMA preparation, cBMA concentration, study methods, outcomes, and level of evidence and reported the results in tables and text.RESULTSA total of 36 studies met inclusion/exclusion criteria and were included in this review. Thirty-one of 36 (86%) studies reported the method of centrifugation and preparation of cBMA with 15 (42%) studies reporting either a cell concentration or an increase from baseline. Variation of cBMA application was seen amongst the studies evaluated. Twenty-one of 36 (58%) were level of evidence IV, 12/36 (33%) were level of evidence III, and 3/36 (8%) were level of evidence II. Studies evaluated full thickness chondral lesions (7 studies), osteochondral lesions (10 studies), osteoarthritis (5 studies), nonunion or fracture (9 studies), or tendon injuries (5 studies). Significant clinical improvement with the presence of hyaline-like values and lower incidence of fibrocartilage on T2 mapping was found in patients receiving cBMA in the treatment of cartilaginous lesions. Bone consolidation and time to bone union was improved in patients receiving cBMA. Enhanced healing rates, improved quality of the repair surface on ultrasound and magnetic resonance imaging, and a decreased risk of re-rupture was demonstrated in patients receiving cBMA as an adjunctive treatment in tendon repair.CONCLUSIONThe current literature demonstrates the potential benefits of utilizing cBMA for the repair of cartilaginous lesions, bony defects, and tendon injuries in the clinical setting. This study also demonstrates discrepancies between the literature with regards to various methods of centrifugation, variable cell count concentrations, and lack of standardized outcome measures. Future studies should attempt to examine the integral factors necessary for tissue regeneration and renewal including stem cells, growth factors and a biologic scaffold.

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

“…27 According to the literature, CBMA injection are administered in combination with several procedures for sports injuries especially such as osteochondral damage, ligament repair, and tendon reconstruction. 28 However, there are no clinical or radiological results concerning CBMA injection combined with meniscal implant surgery. The objective of this study is to evaluate the short-term clinical and radiological outcomes of CBMA injection combined with polyurethane-based medial meniscus implantation in 23 patients.…”

Regenerative Surgery & Intra-Operative Protocols Utilizing Bone Marrow Aspirate Concentrate in Microsurgical & Limb Reconstruction

“…The purpose of this injection is to aid in the vascularization of the periosteum. This, in turn, will release the MSC to differentiate into osteoblasts to achieve bony growth [4]. After performance of osteotomy, gradual lengthening is occurred until desired goal is achieved.…”

Editorial Commentary: Not All Bone Marrow Aspirate Concentrates Are the Same: The Necessity of Detailed Reporting and Other Lessons Learned From Cell-based Treatments in Orthopaedics

“…2 This becomes more critical as randomized controlled trials and systematic reviews that demonstrate some potential benefits from their use are rapidly emerging. [3][4][5][6] In the study "Reporting Standards in Clinical Studies Evaluating Bone Marrow Aspirate Concentrate: A Systematic Review," Drs. Murray, Robinson, West, Goudie, Yong, White, and LaPrade 1 evaluated the level of reporting in a systematic review of studies using BMAC in orthopaedics in relation to the minimum reporting standards.…”