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Regarding “Use of Bone Marrow Aspirate Concentrate With Acetabular Labral Repair for the Management of Chondrolabral Junction Breakdown”

      With great interest, we provide a technique modification and supporting evidence related to our technical note entitled “Use of Bone Marrow Aspirate Concentrate With Acetabular Labral Repair for the Management of Chondrolabral Junction Breakdown,” published in the October 2018 issue of Arthroscopy Techniques.
      • Stelzer J.
      • Martin S.
      Use of bone marrow aspirate concentrate with acetabular labral repair for the management of chondrolabral junction breakdown.
      The senior author (S.D.M.) has performed, in total, over 375 bone marrow aspirations from the body of the ilium (>200 since technique publication), followed by subsequent processing and concentrate application during arthroscopic acetabular labral repair. Moreover, the senior author has experienced no associated complications.
      With additional bone marrow harvests, the senior author noted 2 modifications that contributed to the continued success of this technique. First, to access the ilium, bone marrow aspiration should be performed just proximal to the sourcil. This location has been noted to reliably produce a greater volume of bone marrow, approximately 120 mL, compared with aspiration at the level of the sourcil. Second, the sourcil should be targeted through the Dienst portal with the Jamshidi bone marrow biopsy needle positioned along the coronal plane aiming toward the anterior superior iliac spine. It is important to note that, compared with the sagittal plane, this approach was noted to decrease the risk of hip joint violation and slippage of the needle off the sourcil posteriorly. Overall, these adjustments have improved the repeatability of this technique and the clinical relevance of this harvest location.
      Since publication of our technical note,
      • Stelzer J.
      • Martin S.
      Use of bone marrow aspirate concentrate with acetabular labral repair for the management of chondrolabral junction breakdown.
      numerous subsequent studies have demonstrated the benefits of this bone marrow aspiration site while using this efficient harvest technique. Nazal et al.
      • Nazal M.
      • McCarthy M.
      • Mazzocca A.
      • Martin S.
      Connective tissue progenitor analysis of bone marrow aspirate concentrate harvested from the body of the ilium during arthroscopic acetabular labral repair.
      reported that the body of the ilium provides a rich source of connective tissue progenitor cells that is comparable to or greater than other harvest sites (i.e., distal femur, iliac crest, or proximal humerus), in addition to stating that the procedure is safe with no increase in morbidity or complications. Moreover, Otto et al.
      • Otto A.
      • Muench L.
      • Kia C.
      • et al.
      Proximal humerus and ilium are reliable sources of bone marrow aspirates for biologic augmentation during arthroscopic surgery.
      noted that the body of the ilium was a reliable source of bone marrow aspirate for use in biological augmentation during arthroscopic surgery. Recently, the senior author has shown that augmenting the acetabular labral repair site with bone marrow aspirate concentrate (BMAC) harvested from the body of the ilium resulted in significantly greater functional improvements in patients with moderate osteoarthritis compared with similar patients without BMAC application.
      • Martin S.
      • Kucharik M.
      • Abraham P.
      • Nazal M.
      • Meek W.
      • Varady N.
      Functional outcomes of arthroscopic acetabular labral repair with and without bone marrow aspirate concentrate.
      Finally, Kucharik et al.
      • Kucharik M.P.
      • Abraham P.F.
      • Nazal M.R.
      • et al.
      Treatment of full-thickness acetabular chondral flaps during hip arthroscopy: Bone marrow aspirate concentrate versus microfracture.
      reported that patients with full-thickness chondral flaps treated with BMAC at the time of arthroscopic acetabular labral repair experienced significantly greater improvements in functional outcomes at 12 months’ follow-up compared with patients undergoing microfracture. Thus, as the role of biologics in the field of orthopaedics continues to evolve, this technique serves as a safe, technically feasible, and reproducible method for BMAC harvesting, processing, and application.

      Supplementary Data

      References

        • Stelzer J.
        • Martin S.
        Use of bone marrow aspirate concentrate with acetabular labral repair for the management of chondrolabral junction breakdown.
        Arthrosc Tech. 2018; 7: e981-e987
        • Nazal M.
        • McCarthy M.
        • Mazzocca A.
        • Martin S.
        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
        • Otto A.
        • Muench L.
        • 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
        • Martin S.
        • Kucharik M.
        • Abraham P.
        • Nazal M.
        • Meek W.
        • Varady N.
        Functional outcomes of arthroscopic acetabular labral repair with and without bone marrow aspirate concentrate.
        J Bone Joint Surg Am. 2022; 104: 4-14
        • Kucharik M.P.
        • Abraham P.F.
        • Nazal M.R.
        • et al.
        Treatment of full-thickness acetabular chondral flaps during hip arthroscopy: Bone marrow aspirate concentrate versus microfracture.
        Orthop J Sports Med. 2021; 9 (23259671211059170)

      Linked Article

      • Use of Bone Marrow Aspirate Concentrate with Acetabular Labral Repair for the Management of Chondrolabral Junction Breakdown
        Arthroscopy TechniquesVol. 7Issue 10
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          Despite advances in techniques for acetabular labral repair, strategies for mitigating or reversing damage to the chondrolabral junction do not yet exist. Cartilage repair techniques such as autologous chondrocyte implantation, matrix-induced autologous chondrocyte implantation, osteochondral autograft transfer, microfracture, and bone marrow aspirate concentrate (BMAC) have all been suggested to restore joint congruity and minimize further chondral deterioration. However, chondrocyte implantation techniques and osteochondral grafts are technically challenging in the hip because of its constrained nature, and many cell-based therapies have shown suboptimal results near the chondrolabral junction because of the increased shear forces at the peripheral acetabulum and increased stress at the weight-bearing region of the joint.
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