2015 ISAKOS Biennial Congress ePoster #311
Bone Marrow Aspirate Concentrate in Bone Healing: an Analysis of Basic Science Evidence
Arianna Gianakos, BS, New York, NY UNITED STATES
Amelia Ni, BA, New York, NY UNITED STATES
Lester Zambrana, BA, New York, NY UNITED STATES
Joaquin Moya-Angeler, MD, New York, NY UNITED STATES
John G. Kennedy, MD, FRCS, New York, NY UNITED STATES
Joseph Lane, MD, New York, NY UNITED STATES
Hospital for Special Surgery, New York, New York, USA
FDA Status Not Applicable
Summary: This systematic review demonstrates that the use of BMAC/BMSCs confer several potential beneficial effects on long bone models compared with a control.
Long bone fractures that fail to heal or show a delay in healing can lead to increased morbidity. Bone marrow aspirate concentrate (BMAC) and bone mesenchymal stem cells (BMSCs) have been suggested as an autologous biologic to use as an adjunct to aid long bone healing.
The purpose of this study was to systematically review the basic science in vivo evidence for the use of BMAC and BMSCs in the treatment of pathologic processes of bone. This study intends to determine the effect of BMAC/BMSCs and to establish proof of concept for its use in order to facilitate further investigation at a clinical level.
The PubMed/MEDLINE and EMBASE databases were screened in July 2014 using the following search criteria: (("bmac" OR "bone marrow aspirate concentrate" OR "bmc" OR "bone marrow concentrate" OR "mesenchymal stem cells") AND ("bone" OR "osteogenesis" OR "fracture healing" OR "nonunion" OR "delayed union")). Only basic science in vivo studies examining the effects of BMAC/BMSCs on long bone were included. Data was then extracted and studies were analyzed for trends comparing and contrasting the reported effects of BMAC/BMSCs on bone repair.
The search yielded 35 articles for inclusion in our review. 31 of the 35 studies (88%) reported cell concentrations. Eight studies (23%) reported CD markers and three (8%) studies tested for growth factors which primarily focusing on vascular endothelial growth factor (VEGF). On radiographic evaluation, 14 (100%) of 14 studies reported that defects treated with BMAC/BMSCs showed a statistically significant higher degree of osteogenesis than the control groups. 13 (81%) out of 16 studies that performed a statistical assessment using micro-computed tomography reported a statistically significant increase in mean bone volume fraction values (BV/TV) in groups treated with BMAC/BMSCs compared to untreated control groups. 19 (90%) of 21 studies that evaluated bone regeneration either histologically or histomorphometrically reported a statistically significant increase in the number of osteocytes and a statistically significant increase in bone formation in the experimental groups containing BMAC/BMSCs versus the control group. 7 (78%) out of nine studies reported a statistically significant increase in maximum torque and torsional rigidity in the BMAC/BMSC group when compared to a control group.
In the in vivo studies evaluated, BMAC/BMSCs confer beneficial effects on the healing of long bone models when compared with a control. Radiograph, micro-computed tomography, histologic, histomorphometric, and biomechanical analysis have all demonstrated improved bone regeneration in groups treated with BMAC/BMSCs. Proof of concept has been established for BMAC/BMSCs in the treatment of bone defects as both a primary treatment strategy and an adjunct. Randomized clinical trials are warranted to establish this beneficial effect in a clinical setting. Further standardization of the composition of BMAC is encouraged in order to allow for more accurate reporting of results.