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.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ArthroscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Use of bone marrow aspirate concentrate with acetabular labral repair for the management of chondrolabral junction breakdown.Arthrosc Tech. 2018; 7: e981-e987
- Revision versus primary arthroscopic rotator cuff repair: A 2-year analysis of outcomes in 360 patients.Am J Sports Med. 2015; 43: 557-564
- A systematic review of the concept and clinical applications of bone marrow aspirate concentrate in tendon pathology.SICOT J. 2017; 3: 58
- Biologic options for articular cartilage wear (platelet-rich plasma, stem cells, bone marrow aspirate concentrate).Clin Sports Med. 2017; 36: 457-468
- Quantifying proliferative and surface marker heterogeneity in colony founding connective tissue progenitors and their progeny using time-lapse microscopy.J Tissue Eng Regen Med. 2019; 13: 203-216
- Cell-based approaches for augmentation of tendon repair.Tech Shoulder Elb Surg. 2017; 18: e6-e14
- Effect of donor characteristics, technique of harvesting and in vitro processing on culturing of human marrow stroma cells for tissue engineered growth of bone.Clin Oral Implants Res. 2005; 16: 524-531
- Mesenchymal stem cell-bearing sutures for tendon repair and healing in the foot and ankle.Foot Ankle Clin. 2016; 21: 885-890
- Comparison of mesenchymal stem cells (osteoprogenitors) harvested from proximal humerus and distal femur during arthroscopic surgery.Arthroscopy. 2013; 29: 301-308
- Aspiration of osteoprogenitor cells for augmenting spinal fusion.J Bone Joint Surg Am. 2005; 87: 2655-2661
- Percutaneous bone marrow aspirate and bone graft harvesting techniques in the lower extremity.Clin Podiatr Med Surg. 2008; 25: 733-742
- Percutaneous autologous bone-marrow grafting for nonunions: Influence of the number and concentration of progenitor cells.J Bone Joint Surg Am. 2005; 87: 1430-1437
- Bone marrow concentrate and platelet-rich plasma differ in cell distribution and interleukin 1 receptor antagonist protein concentration.Knee Surg Sports Traumatol Arthrosc. 2018; 26: 333-342
- Percutaneous autologous bone-marrow grafting for nonunions. Surgical technique.J Bone Joint Surg Am. 2006; 88: 322-327
- Reporting standards in clinical studies evaluating bone marrow aspirate concentrate: A systematic review.Arthroscopy. 2018; 34: 1366-1375
- Reporting of mesenchymal stem cell preparation protocols and composition: A systematic review of the clinical orthopaedic literature.Am J Sports Med. 2018; (363546518758667)
- Rapid isolation of human stem cells (connective tissue progenitor cells) from the proximal humerus during arthroscopic rotator cuff surgery.Am J Sports Med. 2010; 38: 1438-1447
- Connective tissue progenitor analysis of bone marrow aspirate concentrate harvested from the body of the ilium during arthroscopic acetabular labral repair.Arthroscopy. 2020; 36: 1311-1320
- Minimal criteria for defining multipotent mesenchymal stromal cells. The International Society for Cellular Therapy position statement.Cytotherapy. 2006; 8: 315-317
- The influence of trocar fenestration and volume on connective tissue progenitor cells (stem cells) in arthroscopic bone marrow aspiration from the proximal humerus.Arthroscopy. 2017; 33: 1167-1174
- Variability in the preparation, reporting, and use of bone marrow aspirate concentrate in musculoskeletal disorders: A systematic review of the clinical orthopaedic literature.J Bone Joint Surg Am. 2018; 100: 517-525
- The posterior iliac crest outperforms the anterior iliac crest when obtaining mesenchymal stem cells from bone marrow.J Bone Joint Surg Am. 2013; 95: 1101-1107
- A systematic review of the concept and clinical applications of bone marrow aspirate concentrate in orthopaedics.SICOT J. 2017; 3: 17
- Anatomy of the ilium for bone marrow aspiration: map of sectors and implication for safe trocar placement.Int Orthop. 2014; 38: 2585-2590
- Reduced levels of mesenchymal stem cells at the tendon-bone interface tuberosity in patients with symptomatic rotator cuff tear.Int Orthop. 2015; 39: 1219-1225
- Biologic augmentation of rotator cuff repair with mesenchymal stem cells during arthroscopy improves healing and prevents further tears: a case-controlled study.Int Orthop. 2014; 38: 1811-1818
- Aspiration to obtain osteoblast progenitor cells from human bone marrow: the influence of aspiration volume.J Bone Joint Surg Am. 1997; 79: 1699-1709
- Aspiration of osteoprogenitor cells for augmenting spinal fusion: comparison of progenitor cell concentrations from the vertebral body and iliac crest.J Bone Joint Surg Am. 2005; 87: 2655-2661
- A simplified method for the aspiration of bone marrow from patients undergoing hip and knee joint replacement for isolating mesenchymal stem cells and in vitro chondrogenesis.Bone Marrow Res. 2016; 2016 (3152065)
- Age- and gender-related changes in the cellularity of human bone marrow and the prevalence of osteoblastic progenitors.J Orthop Res. 2001; 19: 117-125
Article info
Publication history
Published online: June 15, 2020
Accepted:
June 4,
2020
Received:
November 11,
2019
See commentary on page 2412Footnotes
The authors report the following potential conflicts of interest or sources of funding: A.D.M. has received research support and consulting fees from Arthrex, outside the submitted work. The University of Connecticut Health Center/UConn Musculoskeletal Institute receives funding from Arthrex (Naples, Fl, USA). The company had no influence on study design, data collection or interpretation of the results or the final manuscript. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2020 by the Arthroscopy Association of North America
