Bone Marrow

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Bone Marrow

Overview

During the past decade sports medicine, pain management physicians and orthopedic surgeons have found stem cell rich bone marrow aspirate concentrate (BMAC) an excellent clinical tool for facilitating healing and restoration in patients with osteoarthritis, cartilage loss in various joints, bony non-unions, chondral defects, and much more. Bone marrow derived stem cells are an important cell source for cell based therapies. Clinical trial results, have revealed both safety and efficacy of the cell reinfusion procedure in many musculoskeletal conditions, mainly osteoarthritis.

What is Bone Marrow? Bone marrow is soft and spongy tissue that fills the centers of bones. Bone marrow is very unique because it contains a rich supply of immature cell called stem cells. Very important cells found in bone marrow are: mesenchymal and hematopoietic. Hematopoietic stem cell are also called blood-forming stem cells. They can multiply and mature into three significant types of blood cells, each with their own job: erythrocytes, leukocytes, thrombocytes. Mesenchymal cells have been shown to support repair or growth of bone, cartilage, muscle, marrow, tendons, ligaments and connective tissue.

What is BMAC Therapy ? Bone Marrow Aspirate Concentrate therapy is a promising non-surgical regenerative medicine treatment used to treat various musculoskeletal and orthopedic injuries, including mild to moderate osteoarthritis to the knee and tendon injuries. The goal of this procedure is to concentrate regenerative stem cells obtained from a patient’s own bone marrow. Doctor typically removes small amount of bone marrow and spins it in a specialized centrifuge in order to generate a powerful cocktail of concentrate cells that are injected into the injured area.

How is bone marrow obtained? Bone marrow is typically aspirated from iliac crest. Pelvis bone is a common source for harvesting mesenchymal stem cells, other progenitor cells, and associated cytokines and growth factors. Clinical data have reported great outcomes with the use of bone marrow aspirate concentrate (BMAC) for pain relief in the treatment of osteoarthritis of the knee and focal chondral lesions.However, the harvesting and processing technique are extremely important to achieve satisfactory results. At VIP Centers all injections are performed under ultrasound guidance to ensure proper placement of the stem cells.

How does BMAC therapy work ? BMAC (Bone Marrow Aspirate Concentrate) treatment goal is to utilize patient’s own regenerative cells (concentrated bone marrow sample) to minimize joint pain and inflammation, as well as enhance healing and recovery. Studies have shown that stem cells concentrated from bone marrow can help to reduce swelling, relieve joint pain, and enhance healing of articular cartilage and bone. Stem cells harvested from bone marrow are “undifferentiated”, meaning they are able to replicate themselves into various types of tissue. When an injury occurs, the usual number of regenerative cells needed for tissue regeneration is often inadequate. The high dose of concentrated regenerative cells from bone marrow aspirate provides powerful healing of the damaged tissue and aids in growth and repair by accelerating the body’s natural healing mechanism.

Is BMAC procedure painful? BMAC Therapy is minimally invasive procedure that is perform in our office and completed within only a few hours, so patients often have a comfortable visit. Patient comfort is very important, that is why our physicians will communicate with the patient while the procedure is taking place to be sure that discomfort or pain is minimal. You may feel some slight discomfort, however most of our patients tolerate the procedure very well and with minimal pain. The procedure is done under local anesthesia to reduce patient discomfort and ensure a quality experience.

What Should I Expect After the BMAC Treatment?

Following your BMAC procedure you will feel some soreness around the site of injury. This soreness is actually a positive sign that that healing response has started and can last for several days, then gradually decreases as the healing process progresses. Doctor will inform you what medications to avoid after the procedure. Any anti-inflammatory medications such as Ibuprofen, Naproxen and Aspirin should be avoided following treatment as they may contraindicate the effects of the intended healing response facilitated by the post-injection inflammation. Other pain medication such as Tylenol, and in some cases a prescribed pain reliever, which does not have anti-inflammatory properties, to control discomfort as needed are acceptable. After a week these symptoms usually begin to resolve and physical therapy is recommended to optimize stem cells effects and facilitate recovery.

How BMAC procedure is performed?

The bone marrow aspiration procedure is minimally invasive and typically involves small needle extraction. The patient is locally anesthetized for the procedure, and the pelvis is the typical site used for bone marrow extraction. An experienced trained physician will aspirate a small amount of your bone marrow (typically 30 -50 ml). This procedure step is quick our team will ensure that you are comfortable throughout the process.

After bone marrow sample is collected , it is placed in a special centrifuge, which separates the stem cells out of another blood components. Your concentrated stem cells will then be injected back into your body, in the area of damage or injury, to aid in natural healing under fluoroscopic guidance to ensure proper placement. The entire procedure will take about 45 minutes.

What conditions can be treated with BMAC ? Bone Marrow Aspirate Concentrate Therapy is typically recommended for patients that have failed other conservative treatments, including physical therapy, medications, rest, or other conservative injections. It is also a good option for those patient that are not candidates for surgery or simply prefer to avoid or delay surgery.

Conditions that may be treated with stem cells include:

  • Osteoarthritis of the knee, shoulder, elbow, wrist, hand, hip,ankle and foot
  • Rotator cuff tears
  • Articular Cartilage injuries
  • Ligament tears including tears of the UCL in the elbow of throwing athletes
  • Hip labral tears
  • Advanced tendon injuries and high-grade tendon injuries of the shoulder, elbow, hip, knee, ankle and foot
  • Muscle strains or tears

Patients that suffer from arthritis often experience pain, inflammation, stiffness, and decreased range of motion in their joints. They can be a great candidates for stem cells procedure. Injecting the mesenchymal stem cells into affected joints can create an anti-inflammatory response that often helps decrease pain and increase range of motion. Patients experiencing pain from conditions like tendonitis or tendon/ligament tears are also good candidates for stem cell treatment. These ligaments and tendons are connective tissues that stem cells can help to regenerate.

How many injections do I need ?

Usually we do one bone marrow derived stem cell injection, followed up 6 weeks later with a platelet rich plasma injection, however the treatment plan varies from patient to patient.

Is BMAC Therapy safe?

BMAC or mesenchymal stem cell therapy has been safely used in thousands of medical and surgical procedures worldwide. Safety of BMAC procedure was also confirmed in many clinical studies. At VIP Centers we are skilled in the use of the technique for patients who suffer from musculoskeletal injuries and degenerative joint conditions.

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