Bone Marrow Aspirate Concentrate (BMAC) harnesses new technologies in concentrating osteogenic cells and osteoconductive factors found in bone marrow harvested from the iliac crest. Bone marrow is a rich source of hematopoietic and mesenchymal adult stem cells. All cartilage formation is dependent on the recruitment of endothelial progenitor cells and mesenchymal stem cells, both of which are found in adequate concentrations in bone marrow aspirate. Technology is available to concentrate these cells preferentially live in the operating room. The concentrated stem cells are immediately available without modification to inject into pathologic sites that would benefit by the stem cells healing powers. This is similar to grafting skin from one area to another in the same patient during the same procedure. Since the concentrated cells are not grown in culture or modified by pharmacologic agents there is no inherent risk of transplanting the cells themselves. Stem cells from the bone marrow are routinely recruited to injury sites in the normal healing processes. Injecting concentrated bone marrow stem cells into an injured or diseased area is simply enhancing a normal physiologic healing response.
An exciting trend in the treatment of Osteoarthritis is the use of BMAC in the regeneration of lost articular cartilage. At this time, this procedure is in the developmental stages. However, exciting early successes compel us to offer this to our patients even though it is not recognized by insurance companies as accepted treatment. Early results followed for as much as three years have been very encouraging in many cases. Unfortunately, because it is so new insurance reimbursement for this procedure is rare. Therefore, this procedure in most cases is an out-of-pocket expense to the informed patient.
What is Bone Marrow Aspirate Concentrate?
BMAC is a biologic product that is produced through centrifugation of the patient’s own bone marrow. It is harvested, concentrated, and returned to the patient at the time of the associated procedure.
- Enhanced healing of articular cartilage
- Enhanced healing of bone grafts
- Possible regeneration of articular cartilage
- Relief of pain
- Reduced swelling
The known contraindications for Bone Marrow Aspirate Concentrate:
Since this procedure is so new a complete list of contraindications is impossible at this time. If the patient is suffering from ongoing cancer or cancer treatment it would be unwise to transplant stem cells in that patient. A metabolically healthy patient without ongoing disease would be the best candidate for this procedure. A clinical and radiologic evaluation of the stage of osteoarthritis should be done to determine the chance for success. In our early results, it appears that this procedure is less effective in more advanced cases of osteoarthritis.
- Yamasaki T, Deie M, Shinomiya R, et al. (October 2005). “Meniscal regeneration using tissue engineering with a scaffold derived from a rat meniscus and mesenchymal stromal cells derived from rat bone marrow”. J Biomed Mater Res A 75 (1): 23–30.doi:10.1002/jbm.a.30369. PMID 16049928.
- Centeno CJ, Busse D, Kisiday J, Keohan C, Freeman M, Karli D (2008). “Increased knee cartilage volume in degenerative joint disease using percutaneously implanted, autologous mesenchymal stem cells”. Pain Physician 11 (3): 343–53.PMID 18523506.