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Proximal Humerus and Ilium Are Reliable Sources of Bone Marrow Aspirates for Biologic Augmentation During Arthroscopic Surgery

  • Alexander Otto
    Correspondence
    Address correspondence to Alexander Otto, M.D., Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut, 263 Farmington Avenue, Farmington, CT 06032, U.S.A
    Affiliations
    Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut, Farmington, Connecticut, U.S.A.

    Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany

    Department of Trauma, Orthopaedic, Plastic and Hand Surgery, University Hospital of Augsburg, Augsburg, Germany
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  • Lukas N. Muench
    Affiliations
    Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut, Farmington, Connecticut, U.S.A.

    Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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  • Cameron Kia
    Affiliations
    Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut, Farmington, Connecticut, U.S.A.
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  • Joshua B. Baldino
    Affiliations
    Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut, Farmington, Connecticut, U.S.A.
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  • Julian Mehl
    Affiliations
    Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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  • Felix Dyrna
    Affiliations
    Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany

    Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
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  • Andreas Voss
    Affiliations
    Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany

    Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany

    Sporthopaedicum, Straubing-Regensburg, Germany
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  • Mary Beth McCarthy
    Affiliations
    Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut, Farmington, Connecticut, U.S.A.

    Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Partners Health System, Boston, Massachusetts, U.S.A.
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  • Mark R. Nazal
    Affiliations
    Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Partners Health System, Boston, Massachusetts, U.S.A.
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  • Scott D. Martin
    Affiliations
    Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Partners Health System, Boston, Massachusetts, U.S.A.
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  • Augustus D. Mazzocca
    Affiliations
    Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut, Farmington, Connecticut, U.S.A.
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      Purpose

      The purpose of this study was to evaluate the number of colony-forming units (CFUs) derived from concentrated bone marrow aspirates (BMAs) that were processed following arthroscopic harvest from either the proximal humerus or the body of the ilium during biologic augmentation of the rotator cuff and acetabular labral repairs.

      Methods

      Between November 2014 and January 2019, BMA was harvested from the proximal humerus (n = 89) and the body of the ilium (n = 30) during arthroscopic surgery. Following concentration of the aspirate, a 0.5-mL aliquot was further processed and the number of nucleated cells (NC) was counted. Each aliquot was cultured until CFUs were quantifiable. Fluorescence-activated cell sorting analysis and quantitative polymerase chain reaction was performed to confirm presence of mesenchymal stem cells. BMA harvest sites were prospectively assessed and evaluated for differences in age, sex, volume of aspirated BM, and CFUs per milliliter of BMA.

      Results

      The prevalence (38.57 ± 27.92ilium vs. 56.00 ± 25.60humerus CFUs per 106 nucleated cells) and concentration (979.17 ± 740.31ilium vs. 1,516.62 ± 763.63humerus CFUs per 1.0 mL BMA) of CFUs was significantly higher (P < .001, respectively) for BMA harvested from the proximal humerus. Additionally, the estimated total number of cells was significantly higher (P = .013) in BMA from the proximal humerus (97,529.00 ± 91,064.01ilium vs. 130,552.4 ± 85,294.2humerus). There was no significant difference between groups regarding BMA volume (91.67 ± 18.77ilium vs. 85.63 ± 35.61humerus mL; P = .286) and NC count (24.01 ± 5.13ilium vs. 27.07 ± 6.28humerus × 106 per mL BMA; P = .061). The mean age was significantly lower (P < .001) in patients with BMA being harvested from the ilium (30.18 ± 7.63ilium vs. 56.82 ± 7.08humerus years). Patient sex and age had no significant influence on cellular measures within groups (P > .05, respectively).

      Conclusion

      Both proximal humerus and the body of the ilium can be considered reliable sources of bone marrow aspirate for the use in biologic augmentation during their respective arthroscopic surgery. Samples of bone marrow aspirate from the proximal humerus yielded a significantly higher amount of CFUs when compared with samples of BMA obtained from the ilium.
      Level of Evidence: Level II- prospective laboratorial study.
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