Concentrated Bone Marrow Aspirate Is More Cellular and Proliferative When Harvested From the Posterior Superior Iliac Spine Than the Proximal Humerus

Published:October 25, 2021DOI:


      The purpose of this study is to determine whether concentrated bone marrow aspirate (cBMA) from the posterior superior iliac spine (PSIS) or proximal humerus (PH) produces a more productive cellular harvest in patients undergoing arthroscopic rotator cuff repair.


      Patients under 80 years old undergoing surgery for arthroscopic rotator cuff repair were enrolled. Two 60 mL aliquots of BMA were harvested from each subject, one from the PSIS and one from the PH. Each aliquot was processed independently to create cBMA. Cellular composition was determined using an automated hemocytometer and proliferative potential was studied with colony forming unit (CFU) assays.


      Twelve patients were recruited (7 male, 5 female). The average age was 64.3 years (range 46.1-77.25 years) with body mass index of 26.8 (range 20.0-34.3). The average total nucleated cells (TNC) from PH was 18.7 × 106 cells/mL (95% confidence interval [CI], 4.4-33.0; standard deviation [SD], 24.8) with 3.9 CFU/mL (95% CI, 0.3-7.5, SD, 5.7). The average TNC count from the PSIS was 55.9 × 106 cells/mL (95% CI, 25.3-86.4; SD, 52.9) with 32.5 CFU/mL (95% CI, 11.5-53.5; SD, 33.1). The PSIS had a 3.0 times greater total nucleated cell yield (P = .014) and 8.3 times greater number of CFU/mL (P = .024) when compared to the PH. The average harvest time from the PSIS was 5.6 minutes and from the PH was 11.0 minutes (P = .043); harvest time did not account for additional time to prep and drape the PSIS.


      The cBMA harvested from the PSIS resulted in a 3.0 times greater cellular yield and an 8.3 times greater proliferative product than cBMA from the PH. Clinical Relevance: When a more cellular cBMA product is sought to augment rotator cuff tear repair surgery, the PSIS is the preferred site for harvest.
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        • Hauser R.A.
        • Orlofsky A.
        Regenerative injection therapy with whole bone marrow aspirate for degenerative joint disease: A case series.
        Clin Med Insights Arthritis Musculoskelet Disord. 2013; 6: 65-72
        • Hernigou P.
        • Flouzat Lachaniette C.H.
        • Delambre J.
        • et al.
        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
        • Hernigou P.
        • Poignard A.
        • Zilber S.
        • Rouard H.
        Cell therapy of hip osteonecrosis with autologous bone marrow grafting.
        Indian J Orthop. 2008; 43: 40-45
        • Hernigou P.
        • Poignard A.
        • Beaujean F.
        • Rouard H.
        Percutaneous autologous bone-marrow grafting for nonunions.
        J Bone Joint Surg. 2005; 87: 1430-1437
        • Saw K.Y.
        • Anz A.
        • Siew-Yoke Jee C.
        • et al.
        Articular cartilage regeneration with autologous peripheral blood stem cells versus hyaluronic acid: A randomized controlled trial.
        Arthroscopy. 2013; 29: 684-694
        • Sherman B.J.
        • Chahla J.
        • Glowney J.
        • Frank R.M.
        The role of orthobiologics in the management of osteoarthritis and focal cartilage defects.
        Orthopedics. 2019; 42: 66-73
        • Vangsness Jr., C.T.
        • Sternberg H.
        • Harris L.
        Umbilical cord tissue offers the greatest number of harvestable mesenchymal stem cells for research and clinical application: A literature review of different harvest sites.
        Arthroscopy. 2015; 31: 1836-1843
        • Kitoh H.
        • Kitakoji T.
        • Tsuchiya H.
        • Katoh M.
        • Ishiguro N.
        Transplantation of culture expanded bone marrow cells and platelet rich plasma in distraction osteogenesis of the long bones.
        Bone. 2007; 40: 522-528
        • Ellera Gomes J.L.
        • da Silva R.C.
        • Silla L.M.
        • Abreu M.R.
        • Pellanda R.
        Conventional rotator cuff repair complemented by the aid of mononuclear autologous stem cells.
        Knee Surg Sports Traumatol Arthrosc. 2012; 20: 373-377
        • Hyer C.F.
        • Berlet G.C.
        • Bussewitz B.W.
        • Hankins T.
        • Ziegler H.L.
        • Philbin T.M.
        Quantitative assessment of the yield of osteoblastic connective tissue progenitors in bone marrow aspirate from the iliac crest, tibia, and calcaneus.
        J Bone Joint Surg Am. 2013; 95: 1312-1316
        • Pierini M.
        • Di Bella C.
        • Dozza B.
        • et al.
        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
        • Vasiliadis A.V.
        • Galanis N.
        Human bone marrow-derived mesenchymal stem cells from different bone sources: A panorama.
        Stem Cell Invest. 2020; 7: 15
        • Oliver K.
        • Awan T.
        • Bayes M.
        Single- versus multiple-site harvesting techniques for bone marrow concentrate: Evaluation of aspirate quality and pain.
        Orthop J Sports Med. 2017; 5 (2325967117724398)
        • Narbona-Carceles J.
        • Vaquero J.
        • Suárez-Sancho S.
        • Forriol F.
        • Fernández-Santos M.E.
        Bone marrow mesenchymal stem cell aspirates from alternative sources: Is the knee as good as the iliac crest?.
        Injury. 2014; 45: S42-S47
        • Beitzel K.
        • McCarthy M.B.
        • Cote M.P.
        • et al.
        Comparison of mesenchymal stem cells (osteoprogenitors) harvested from proximal humerus and distal femur during arthroscopic surgery.
        Arthroscopy. 2013; 29: 301-308
        • Otto A.
        • Muench L.N.
        • Kia C.
        • et al.
        Proximal humerus and ilium are reliable sources of bone marrow aspirates for biologic augmentation during arthroscopic surgery.
        Arthroscopy. 2020; 36: 2403-2411