Use of bone marrow aspirate concentrate (BMAC) in the treatment of delayed unions and nonunions: a single-center case series
Keywords:
bone marrow aspirate concentrate, BMAC, delayed union, nonunionAbstract
Background and aim: Surgical treatment of delayed unions and nonunions requires adherence to the principles of mechanical stability, as well as consideration of biological environment. Bone marrow aspirate concentrate (BMAC) provides cellular and growth factor supply acting as an osteoinductive and osteogenic stimulus in bone healing. The aim of the study is to analyze the outcome of delayed unions and nonunions treatment with autologous bone marrow concentrate supplementation at our institution.
Methods: Study included all patients treated at the Orthopedic and Traumatology Unit of Cattinara Hospital-ASUGI (Trieste, Italy) between September 2015 and January 2022 for delayed union or nonunion who received bone marrow aspirate concentrate (BMAC) supplementation. Initial treatment, definitive surgical treatment, radiographic healing and complications were retrospectively evaluated. Data collection was conducted by clinical database searching.
Results: The study population included 11 patients, F:M 7:4, mean age 61 years. Initial treatment was surgical in 82% of patients. Radiographic healing of the fracture occurred in 100% of cases. None of the patients presented complications.
Conclusions: Bone marrow aspirate concentrate (BMAC) has shown encouraging results and a high safety profile. Thus, it could be an effective and safe method in the treatment of delayed unions and nonunion. However, further studies will be needed to clarify its role.
References
Andrzejowski P, Giannoudis PV. The 'diamond concept' for long bone non-union management. J Orthop Traumatol. 2019 Apr 11;20(1):21.
Einhorn TA. Enhancement of fracture-healing. J Bone Joint Surg. 1995;77:940–956.
Bell A, Templeman D, Weinlein JC. Nonunion of the femur and tibia: an update. Orthop Clin N Am. 2016;47:365–375.
Harrell DB, Caradonna E, Mazzucco L, et al. Non-hematopoietic essential functions of bone marrow cells: A review of scientific and clinical literature and rationale for treating bone defects. Orthop. Rev. (Pavia) 2015, 7, 5691.
Fitzgibbons TC, Hawks MA, McMullen ST, et al. Bone grafting in surgery about the foot and ankle: indications and techniques. J Am Acad Orthop Surg. 2011;19:112–120.
Wilkins RM, Kelly CM. The effect of allomatrix injectable putty on the outcome of long bone applications. Orthopedics. 2003; 26(5 Suppl): s567-s570.
Connolly JF, Guse R, Tiedeman J, et al. Autologous marrow injection as a substitute for operative grafting of tibial nonunions. Clin Orthop Relat Res. 1991;266:259–270.
Gianakos A, Ni A, Zambrana L, et al. Bone marrow aspirate concentrate in animal long bone healing: an analysis of basic science evidence. J Orthop Trauma. 2016;30:1–9.
Braly HL, O’connor DP, Brinker MR. Percutaneous autologous bone marrow injection in the treatment of distal meta-diaphyseal tibial nonunions and delayed unions. J Orthop Trauma. 2013;27:527–533.
Hernigou PH, Poignard A, Beaujean F, et al. Percutaneous autologous bone-marrow grafting for nonunions. J Bone Joint Surg Am. 2005;87-A:1430–1437.
Agarwal R, Williams K, Umscheid CA, Welch WC. Osteoinductive bone graft substitutes for lumbar fusion: A systematic review. J Neurosurg Spine. 2009; 11(6): 729-740.
Burwell RG. The function of bone marrow in the incorporation of a bone graft. Clin Orthop Relat Res. 1985;(200)(200):125-141.
Lindholm TS, Urist MR. A quantitative analysis of new bone formation by induction in compositive grafts of bone marrow and bone matrix. Clin Orthop Relat Res. 1980;(150)(150):288–300.
Liebergall M, Schroeder J,Mosheiff R, et al. Stem cell-based therapy for prevention of delayed fracture union: A randomized and prospective preliminary study. Mol Ther. 2013; 21(8): 1631-1638.
Salama R, Weissman SL. The clinical use of combined xenografts of bone and autologous red marrow. A preliminary report. J Bone Joint Surg (Br). 1978; 60(1): 111-115.
Tiedeman JJ, Connolly JF, Strates BS, Lippiello L. Treatment of nonunion by percutaneous injection of bone marrow and demineralized bone matrix. an experimental study in dogs. Clin Orthop Relat Res. 1991;(268)(268):294–302.
Imam MA, Holton J, Ernstbrunner L, et al. A systematic review of the clinical applications and complications of bone marrow aspirate concentrate in management of bone defects and nonunions. Int Orthop. 2017 Nov;41(11):2213-2220.
Wittauer M, Burch MA, McNally M, et al. Definition of long-bone nonunion: A scoping review of prospective clinical trials to evaluate current practice. Injury. 2021 Nov;52(11):3200-3205.
Nicholson JA, Makaram N, Simpson A, Keating JF. Fracture nonunion in long bones: A literature review of risk factors and surgical management. Injury. 2021 Jun;52 Suppl 2:S3-S11.
Calori GM, Mazza E, Colombo M, Ripamonti C, Tagliabue L. Treatment of long bone non-unions with polytherapy: indications and clinical results. Injury. 2011 Jun;42(6):587-90.
Le Nail LR, Stanovici J, Fournier J, Splingard M, Domenech J, Rosset P. Percutaneous grafting with bone marrow autologous concentrate for open tibia fractures: analysis of forty three cases and literature review. Int Orthop. 2014 Sep;38(9):1845-53.
Benshabat D, Factor S, Maman E, et al. Addition of Bone Marrow Aspirate Concentrate Resulted in High Rate of Healing and Good Functional Outcomes in the Treatment of Clavicle Fracture Nonunion: A Retrospective Case Series. J Clin Med. 2021 Oct 16;10(20):4749.
Kassem MS. Percutaneous autogenous bone marrow injection for delayed union or non union of fractures after internal fixation. Acta Orthop Belg. 2013 Dec;79(6):711-7.
Singh AK, Shetty S, Saraswathy JJ, Sinha A. Percutaneous autologous bone marrow injections for delayed or non-union of bones. J Orthop Surg (Hong Kong). 2013 Apr;21(1):60-4.
Lin K, VandenBerg J, Putnam SM, et al. Bone marrow aspirate concentrate with cancellous allograft versus iliac crest bone graft in the treatment of long bone nonunions. OTA Int. 2019 Mar 12;2(1):e012.
Thua T, Bui D, Nguyen DT, et al. Autologous Bone Marrow Stem Cells combined with Allograft Cancellous Bone in Treatment of Nonunion. Biomed Res Ther 2015 Dec; 2, 29
Elattar O, Christophersen CM, Farber D. Pain and Complications Following Bone Marrow Aspirate Concentrate Harvested From the Iliac Crest in Foot and Ankle Surgery. Foot Ankle Spec. 2021 Jun 18:19386400211017379.
Bain BJ. Bone marrow biopsy morbidity and mortality. Br J Haematol. 2003 Jun;121(6):949-51.
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