Bone marrow aspirate concentrate (BMAC) is a promising non-surgical treatment modality for the treatment of various musculoskeletal diseases. BMAC has become an increasingly popular alternative and adjunct in the treatment of cartilaginous lesions, nerve lesions, bony defects, and muscular/tendinous injuries. These tissues have inadequate blood supply, healing potential and regenerative capacity resulting with insufficient repair of the damaged parts. BMAC is a concentrate of regenerative stem cells obtained from patient’s own bone marrow, and like PRP, it enhances the body’s intrinsic healing potential.
Bone marrow is a source of mesenchymal stem cells, and other cells (e.g MUSE cells) that are potentially effective in tissue regeneration. It contains a high concentration of growth factors, which are reported to have anabolic and anti- inflammatory effects. BMAC stimulates tissue regeneration and repair resulting with faster and more robust healing of the target tissue. The mesenchymal stem cells have potential to transform into cartilage, bone or tendon cells, however they rather stimulate the cells that are responsible for the tissue production. The quality (regenerative capacity) and quantity (number/content) of the stem cells may vary depending on age.
Bone marrow aspirate concentrate (stem cell therapy) is usually for patients who have more moderate to severe orthopedic conditions like osteoarthritis and ligament/tendon tears.
The previous literature have revealed good outcomes for BMAC in the treatment of osteochondral defect and osteochondral lesions (knee, ankle), lumbar arthrodesisosteonecrosis of femoral head, osteoarthritis, fracture repair, rotator cuff pathology of the shoulder, discogenic pain, anterior cruciate ligament tear (knee), hip pain (acetabular bone defect), tennis/golfer’s elbow, meniscus tears and achilles tendon tendinitis/rupture. BMAC can also be used during orthopedic surgery (eg. Avascular necrosis of the femoral head).
Bone marrow aspirate (BMA) has some advantages as its relative ease of harvest, low morbidity, and feasible cost. BMA alone has a relatively low percentage of mesenchymal stem cell (MSC)s and therefore concentrated bone marrow aspirate is used in clinical practice.
Bone marrow aspiration procedure can be performed with minimal discomfort by the specialists having appropriate expertise. Simply, first the target area for BMA is determined. Then the needle is advanced through pelvic bone preferably under ultrasound or flouroscopy guidance. The bone marrow is aspirated from multiple sites in order to increase the number/content of stem cells. After filtration and centrifugation, the BMAC is injected to the target location (joint, tendon, or etc).
Patient may feel immediate pain just after injection due to injection procedure which usually resolves within a few minutes or hours, and also a low grade pain due to inflammation which resolves within a few days. The BMAC injection procedure does not require culture expansion. As the patients own bone marrow is used there is no risk of allogenic disease transmission. The risk of infection is low. It's important to avoid using all anti-inflammatory medications like ibuprofen, naproxen and aspirin as they may impair the healing process.
About one week after the procedure, patients are encouraged to begin physical therapy in order to accelerate recovery and increase the benefit of the procedure. Most patients see some level of improvement (increased strength and stability) within 2-6 weeks. The pain relief and tissue repair tend to continue during a year and patients report lower degrees of pain. Over the course of 3 months prior to the injections, patients who are able (specifically ones who are in a physical therapy program and are remaining active in order to further strengthen their muscles) do experience more recovery benefits.
The regenerative and biologic procedures are not yet covered by most of the insurance companies, however some of them cover PRP. You can speak with an insurance specialist at Lokman Hekim Akay Hospital.
Alper Murat ULAŞLI
MD. Associate Professor
Physical Medicine and Rehabilitation
Lokman Hekim Akay Hospital