What is bone marrow stem cell therapy?Доц. Альпер Мурат УЛАШЛЫ Создано: 2018-09-14 12:21:01
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What is bone marrow stem cell therapy?

What is bone marrow stem cell therapy?


What is bone marrow stem cell therapy?

What is bone marrow stem cell therapy?

Bone marrow aspirate concentrate (BMAC) is a promising non-surgical treatment modality for the treatment of various musculoskeletal diseases including cartilaginous lesions, bony defects, and tendinous injuries. BMAC is a concentrate of regenerative stem cells obtained from patient’s own bone marrow. BMAC is a reservoir of mesenchymal stem cells and growth factors that enhance healing process of the cartilage, bone or tendon/ligament. Stem cells have potential to replicate and transform into various tissue types. However, after injection to the target tissue, stem cells organise and induce the healing process rather then transforming to the cartilage or bone cells.

In which conditions BMAC can be used?

Cartilage, tendon/ligament, muscle and nerve tissues have inadequate healing potential and regenerative capacity resulting with insufficient repair after the injuries. Altough BMAC treatment is still at the proof-of-concept stage, the previous literature revealed acceptable outcomes of BMAC in the treatment of osteochondral defect and osteochondral lesions (knee, ankle), lumbar arthrodesis, osteonecrosis of femoral head, osteoarthritis (knee, hip), fracture repair, rotator cuff pathology of the shoulder, discogenic pain, anterior cruciate ligament tear (knee), acetabular bone defect, tibial bone defect, tennis elbow, and achilles tendon rupture.

Who are candidates for BMAC treatment?

Patients who did not get benefit from primarily applied conventional treatment modalities (physical therapy and rehabilitation, non-steroidal anti inflammatory drugs, activity modification and etc.) at least 3 months. Patients who rejects or wants to postpone surgical treatment. BMAC can also be used as an adjunct therapy to the surgery.

Contraindications

Patients who have

-Acute infectious disease that require antibiotic treatment,

-Platelet dysfunction.

-Immune compromisation,

-Blood cancer

How it is performed?

Bone marrow aspiration procedure can be performed with minimal discomfort by the specialists having appropriate expertise. Simply, first the target area for BMA is determined (usually iliac bone of pelvis). Then the needle is advanced through pelvic bone preferably under ultrasound or flouroscopy guidance with local anesthesia, with/without having sedation. The bone marrow is aspirated from multiple sites in order to increase the number/content of stem cells. After filtration and density centrifugation, the BMAC is injected to the target location (joint, tendon, or etc) under ultrasound guidance.

Most patients tolerate the procedure very well. Patients may feel immediate pain just after injection due to injection procedure which usually resolves within a few minutes or hours, and also a low grade pain due to inflammation which resolves within a few days.

All procedure should be performed under sterile conditions. The entire procedure lasts about two hours. The patient can be discharged in the same day.

After the procedure

Absolute rest during first 2 days is recommended. The patient can begin rehabilitation programme 1 week after the injection, starting with range of motion and isometric strengthening exercises. Your doctor may offer a control visit one month after the procedure. Patients are allowed to have a bath 2 days after the procedure.

In case of pain at the injection or bone marrow aspiration site, cold pack is recommended in first two days. Paracetamol or tramadol can be used for pain management, however using non-steroidal anti-inflammatory drugs like naproxen, ibuprofen or diclofenac must be avoided as they may impair the healing process.

How many treatments will be needed?
Most clinicians recommend a single BMAC treatment depending on the degree of the injury. However, in challenging cases, a second BMAC injection might be considered months later. A PRP injection one month after the BMAC injection might also be recommended.

The benefits from the BMAC treatment.

The response to BMAC treatment varies among patients and injuries. The severity and the chronicity of the injury, the age and concomittan diseases of the patient may effect the outcome of the treatment.


Are there any contraindications (i.e. exclusion criteria) that would inhibit someone from getting BMC?

Bone marrow derived cancer (such as lymphoma), non-bone marrow derived cancer or metastatic disease (should be checked with your oncologist), and active systemic infection are all contra-indications. Blood thinning medications such as Coumadin must be discontinued and managed appropriately by your cardiologist or primary doctor prior to the procedure.

Is BMC covered by Insurance?
No. While there are currently several publications in peer-reviewed medical journals showing the positive effects of BMC therapy on tendon, soft tissue, and cartilage injuries, BMC is still not covered by insurance companies at this time.

How long does it take BMC to "work"?
Most patients notice some level of improvement by 2-6 weeks following BMC. Increased stability and strength are typically reported along with the decrease in pain. A second level of benefits may be obtained between 6 weeks and 3months. Patients are encouraged to remain active with a functional rehabilitation program and strengthen surrounding muscles during this period.


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