2017 ISAKOS Biennial Congress ePoster #313


The Influence Of Trocar Fenestration And Volume On Connective Tissue Progenitor Cells (Stem Cells) In Arthroscopic Bone Marrow Aspiration From The Proximal Humerus

Andreas Voss, MD, Regensburg, BY GERMANY
Mary Beth McCarthy, BA, Farmington, United States of Ame UNITED STATES
Hardeep Singh, MD, Farmington, CT UNITED STATES
Alexander Hoberman, BS, Farmington, CT UNITED STATES
Knut Beitzel, Prof. Dr., Cologne GERMANY
Andreas B. Imhoff, MD, Prof. Emeritus, Sauerlach / Munich, Bavaria GERMANY
Augustus D. Mazzocca, MS, MD, Waltham, MA UNITED STATES

UConn Musculoskeletal Institute University of Connecticut, Department of Orthopaedic Surgery, Farmington, CT, UNITED STATES

FDA Status Not Applicable


Recent literature has shown that the amount of stem cells correlate with positive outcomes. This suggest that the use of non-fenestrated trocar maybe more efficient to obtain CTPs from the proximal humerus.

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Obtaining bone marrow (BM) derived stem cells, commonly called connective tissue pro-genitor cells (CTPs), is a new and evolving technique to augment tendon to bone healing. The purpose of this study was to compare the number of CTPs and nucleated cells obtained during bone marrow aspi-ration (BMA) from the epiphysis of the proximal humerus using either a fenestrated or a non-fenestrated trocar and determine differences in varying amounts of aspiration volume.


The number of CTPs extracted with the fenestrated trocar would be greater due to its po-tential to extract more cells through its fenestrations. Additionally, consecutive aspirations would result in a consistent number of CTPs and nucleated cells.


Twenty-four patients underwent BMA from the proximal humerus during arthroscopic surgery. Patients were randomly assigned to 2 groups: 1) non-fenestrated and 2) fenestrated trocar. Four consecutive 12ml double-syringes were used for each aspiration: 1(0-12ml), 2(12-24ml), 3(24-36ml), 4(36-48ml). One ml was removed from each syringe (non-concentrated BMA). The remainder of the BMA was then spun using a centrifuge. BMA and concentrated BMA were brought to the laboratory, counted for nucleated cells and cultured for 7 days to obtain colony-forming units.


No significant differences were observed in tubes 1-3 (tube4: p=0.01) in the number of nucleated cells in the non-concentrated BMA using the non-fenestrated trocar compared to the fenestrated trocar (all p>0.05). Significant differences were observed in tubes 1, 3 and 4 (tube2: p=0.23) in the number of nucleated cells in the concentrated BMA using the non-fenestrated compared to the fenestrated trocar (all p>0.05). Non-concentrated and concentrated BMA from tubes 1-4 had a significantly higher CTP prevalence using the non-fenestrated trocar (all p>0.05).


Aspiration from the proximal humerus with the non-fenestrated trocar during BMA was associated with higher prevalence of CTPs, suggesting that more CTPs can be obtained using a non-fenestrated trocar. Furthermore CTPs can be obtained through all consecutive aspirations.