Bone Marrow Aspirate Concentrate and Its Uses in the Foot and Ankle

2018 ◽  
Vol 35 (1) ◽  
pp. 19-26 ◽  
Author(s):  
James M. Cottom ◽  
Britton S. Plemmons
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Aspirate ◽  
Foot And Ankle ◽  
Bone Marrow Aspirate Concentrate

scholarly journals Outcomes Following the Treatment of Talar Osteochondral Lesions with BioCartilage and Bone Marrow Aspirate Concentrate Mixture

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0004
Author(s):  
Ashraf Fansa ◽  
Mark Drakos ◽  
Taylor Cabe ◽  
Peter Fabricant
Keyword(s):  
Bone Marrow ◽  
Patient Reported Outcomes ◽  
Bone Marrow Aspirate ◽  
Statistical Significance ◽  
Osteochondral Lesions ◽  
Foot And Ankle ◽  
Bone Marrow Aspirate Concentrate ◽  
Patient Reported ◽  
The Mean

Category: Arthroscopy Introduction/Purpose: With reported incidence rates ranging from 40% to 70% post ankle sprains and fractures, osteochondral lesions of the talus (OLT) are not uncommon. However, management of such defects remains challenging. Microfracturing is considered the standard treatment for symptomatic OLTs.Larger lesions however typically require more invasive restorative procedures such as autologous osteochondral transplantation. Microfracture results are variable due to the fact that the resulting reparative fibrocartilage is weaker and biomechanically inferior to native hyaline cartilage. In this study, we examine the functional and radiological outcomes following use of a new arthroscopic technique utilizing a mixture of micronized allograft cartilage matrix (BioCartilage) (Arthrex, Naples, FL) soaked in Bone Marrow Aspirate Concentrate (BMAC) to fill OLTs. Methods: Eighty-six consecutive patients treated for OLT using arthroscopic debridement and BioCartilage matrix soaked in BMAC were identified. All patients were treated by a single fellowship-trained sports medicine and foot and ankle surgeon. Functional outcomes were assessed using the Foot and Ankle Outcome Score (FAOS) and Patient-Reported Outcomes Measurement Information System (PROMIS). This information was obtained from a prospective registry at the authors’ institution. Wilcoxon signed rank tests were used to determine statistical significance between pre and postoperative clinical scores. Additionally, an attending radiologist assessed the reparative cartilage morphology on postoperative MRI scans. This was evaluated and scored using a modified magnetic resonance observation of cartilage tissue (MOCART) scoring system. Results: Thirty-one patients (19 Females; 12 Males) with a mean age of 37.8 years (Range 15–54) had a minimum follow-up duration of 12 months and were thus included in this review. Mean follow-up duration was 15.8 months (Range 12 –25.7). The mean patient BMI was 27.4 (Range 19.6 – 39.4), while the average osteochondral lesion size was 85.9 mm2 (Range 35 – 220). The Physical Function domain of the PROMIS score, demonstrated statistically significant change, improving from 40.63 ±8.31 to 48.31 ±10.07 (p=0.02). The Pain Intensity domain also improved significantly from 49.06 ±9.32 to 42.14 ±9.38 (p=0.03). The Pain Interference domain and FAOS scores did improve but not reaching statistical significance. The mean MRI MOCART score was 69 ±13.34 with 13.3 months average follow-up duration. Conclusion: Achieving the longest duration possible of symptom-free functioning postoperatively is the main goal of any cartilage repair procedure. Augmentation of an articular lesion’s infill with BioCartilage and BMAC may help enhance the biomechanical properties of the reparative fibrocartilage construct and its longevity. Our initial findings demonstrate favorable patient-reported outcomes. Moreover, postoperative MRIs demonstrate the majority of the lesions showed either complete or hypertrophic infill, complete or hypertrophic integration, homogenous repair tissue, and isointense signals. Long-term studies prospectively assessing the effectiveness of this technique in maintaining pain-free-function of the ankle joint are warranted.

Topical Review: Bone Marrow Aspirate Concentrate and Its Clinical Use in Foot and Ankle Surgery

2021 ◽  
pp. 107110072110210
Author(s):  
Rachel Glenn ◽  
William Johns ◽  
Kempland Walley ◽  
J. Benjamin Jackson ◽  
Tyler Gonzalez
Keyword(s):  
Bone Marrow ◽  
Orthopedic Surgery ◽  
Animal Studies ◽  
Clinical Evidence ◽  
Bone Marrow Aspirate ◽  
Foot And Ankle ◽  
Soft Tissue Healing ◽  
Bone Marrow Aspirate Concentrate ◽  
Tissue Healing ◽  
Ankle Surgery

Bone marrow aspirate concentrate (BMAC) is now commonly used in orthopedic surgery. Animal studies showed promising results for cartilage, bone, and soft tissue healing; however, many of these outcomes have yet to be translated to human models. While there has been an increase in the use of BMAC in foot and ankle procedures, the associated clinical evidence is limited. The purpose of this review is to analyze the existing literature in order to evaluate the safety and efficacy of BMAC in foot and ankle surgery.

Pain and Complications Following Bone Marrow Aspirate Concentrate Harvested From the Iliac Crest in Foot and Ankle Surgery

2021 ◽  
pp. 193864002110173
Author(s):  
Osama Elattar ◽  
Christy M. Christophersen ◽  
Daniel Farber
Keyword(s):  
Bone Marrow ◽  
Patient Satisfaction ◽  
Bone Graft ◽  
Iliac Crest ◽  
Bone Marrow Aspirate ◽  
Safe Procedure ◽  
Foot And Ankle ◽  
Bone Marrow Aspirate Concentrate ◽  
Harvest Site

Background Autologous bone graft is the gold standard in orthopedics, with the iliac crest the most common harvest site. In an attempt to minimize morbidity with open bone graft harvest from the iliac crest and still maintain the benefit of collecting and transplanting live cells and growth factors, bone marrow aspirate concentrate (BMAC) from the iliac crest has become increasingly popular. However, any harvest procedure can potentially cause pain and complications. The purpose of this study was to evaluate the safety and complications of BMAC from the iliac crest for use in foot and ankle fusion procedures. Methods A retrospective chart review was performed on all patients who underwent BMAC harvest from the iliac crest with their foot or ankle procedure by 1 of 4 fellowship-trained surgeons (2014-2017) with a minimum of 6-month follow-up. Patients were evaluated for complications, pain, and functional limitation secondary to the harvest. The final outcome follow-up was conducted using a specifically designed telephone questionnaire to assess patient satisfaction. A total of 55 patients were included, with a median age of 58 years (range 31-81 years) and 69% were women. Results Out of 55 patients, 52 (94.5%) reported good to excellent results, and satisfaction with the procedure at the time of the questionnaire. Three patients reported persistent complications and some element of dissatisfaction after 6 months. Some patients reported transient complications (hematomas and numbness) that eventually resolved. Fifty percent of patients reported some element of immediate post-operative pain. However, at the time of final follow-up, only 2 reported persistent pain at the harvest site lasting up to 6 months, but it was not activity limiting. Conclusion BMAC harvest is a safe procedure with a high rate of patient satisfaction and minimal morbidity. Levels of Evidence Level IV: Case series

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

Bone Marrow Aspirate Concentrate for Bone Healing in Foot and Ankle Surgery

2016 ◽  
Vol 21 (4) ◽  
pp. 839-845 ◽  
Author(s):  
Joshua S. Harford ◽  
Travis J. Dekker ◽  
Samuel B. Adams
Keyword(s):  
Bone Marrow ◽  
Bone Healing ◽  
Bone Marrow Aspirate ◽  
Foot And Ankle ◽  
Bone Marrow Aspirate Concentrate ◽  
Ankle Surgery

Comparison of Juvenile Allogenous Articular Cartilage and Bone Marrow Aspirate Concentrate Versus Microfracture With and Without Bone Marrow Aspirate Concentrate in Arthroscopic Treatment of Talar Osteochondral Lesions

2018 ◽  
Vol 39 (4) ◽  
pp. 393-405 ◽  
Author(s):  
Sydney C. Karnovsky ◽  
Bridget DeSandis ◽  
Amgad M. Haleem ◽  
Carolyn M. Sofka ◽  
Martin O’Malley ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Magnetic Resonance ◽  
Functional Outcomes ◽  
Bone Marrow Aspirate ◽  
Size Difference ◽  
Osteochondral Lesions ◽  
Foot And Ankle ◽  
Bone Marrow Aspirate Concentrate ◽  
Outcome Score

Background: The purpose of this study was to compare the functional and radiographic outcomes of patients who received juvenile allogenic chondrocyte implantation with autologous bone marrow aspirate (JACI-BMAC) for treatment of talar osteochondral lesions with those of patients who underwent microfracture (MF). Methods: A total of 30 patients who underwent MF and 20 who received DeNovo NT for JACI-BMAC treatment between 2006 and 2014 were included. Additionally, 17 MF patients received supplemental BMAC treatment. Retrospective chart review was performed and functional outcomes were assessed pre- and postoperatively using the Foot and Ankle Outcome Score and Visual Analog pain scale. Postoperative magnetic resonance images were reviewed and evaluated using a modified Magnetic Resonance Observation of Cartilage Tissue (MOCART) score. Average follow-up for functional outcomes was 30.9 months (range, 12-79 months). Radiographically, average follow-up was 28.1 months (range, 12-97 months). Results: Both the MF and JACI-BMAC showed significant pre- to postoperative improvements in all Foot and Ankle Outcome Score subscales. Visual Analog Scale scores also showed improvement in both groups, but only reached a level of statistical significance ( P < .05) in the MF group. There were no significant differences in patient reported outcomes between groups. Average osteochondral lesion diameter was significantly larger in JACI-BMAC patients compared to MF patients, but size difference had no significant impact on outcomes. Both groups produced reparative tissue that exhibited a fibrocartilage composition. The JACI-BMAC group had more patients with hypertrophy exhibited on magnetic resonance imaging (MRI) than the MF group ( P = .009). Conclusion: JACI-BMAC and MF resulted in improved functional outcomes. However, while the majority of patients improved, functional outcomes and quality of repair tissue were still not normal. Based on our results, lesions repaired with DeNovo NT allograft still appeared fibrocartilaginous on MRI and did not result in significant functional gains as compared to MF. Level of Evidence: Level III, comparative series.

BONE MARROW ASPIRATE CONCENTRATE INJECTION OF THE ACHILLES TENDON IN A COMPETITIVE DISTANCE RUNNER

2021 ◽  
pp. 2140004
Author(s):  
Kathryn A. Farina ◽  
Blake A. Kandah ◽  
Nan M. Sowers ◽  
Gregory A. Moore
Keyword(s):  
Bone Marrow ◽  
Achilles Tendon ◽  
Bone Marrow Aspirate ◽  
Return To Sport ◽  
Distance Runner ◽  
Complication Rates ◽  
Bone Marrow Aspirate Concentrate ◽  
Progressive Return ◽  
Competitive Athletes ◽  
Lateral Margins

Achilles tendon disorders, including tendinopathy and ruptures, are common among competitive runners. Relatively high complication rates, recurring injuries, and the need to return to sport have led to the use of regenerative medical treatment in tendon disorders in competitive athletes. Biologic therapies, including bone marrow aspirate concentrate (BMAC) injections, have been effective in restoring injured tissue in a limited number of cases. In this case, a collegiate cross country runner with Achilles tendon pain underwent years of failed, non-surgical conservative management. The patient’s MRI demonstrated moderate distal calcaneus tendinosis with high-grade partial thickness tearing of the anterior fibers of the Achilles tendon (50% tear). The patient underwent peritendinous injection of BMAC. Post-procedure MRI demonstrated minimal tendinosis of the distal and lateral margins of the Achilles tendon, and no evidence of Achilles tendon tear. The patient followed a progressive return to running program, ultimately training 40 miles per week with minimal Achilles tendon pain.

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