Author: Sean Mulvaney, MD
Bone marrow aspirate concentrate (BMAC) can focus your own body’s ability to heal. BMAC has been in clinical use since the 1990’s and and many reliable studies demonstrate it’s potential benefits in orthopedic or musculoskeletal injuries.
Your bone marrow is a rich source of mesenchymal stem cells (MSCs). These cells bind to an injury site and initiate and organize repair to the damaged tissue. MSCs are a potent tool for focusing the body’s natural repair process.
Precisely placing BMAC into the injury site can initiate the healing process by activating the damaged cartilage or tendon. This is an inflammatory process, but don’t worry. Inflammation is the vital first phase of healing.
What to Expect
First, your bone marrow is aspirated or drawn out of the back part of the pelvis. But don’t worry, this is really not as bad as it might sound.
To make the procedure more comfortable and to numb the bone marrow cavity, we will do a procedure called a caudal epidural, where we will inject 10 milliliters of a numbing medicine (lidocaine) into the epidural space just above the cleft in your buttocks.
After we map the procedure with ultrasound guidance, sterile ultrasound gel and a skin marking pen, we numb the skin and the surface of the bone at the aspiration site. Once the skin is numb, we use a special needle to enter the bone marrow cavity in the hip bones near your lower back.
Then we aspirate the bone marrow into a syringe with a small amount of anti-coagulant (heparin) in it to keep the bone marrow from clotting during this process. Let us know if you have an allergy to heparin.
This process is repeated at least at three sites on the bone, but up to six sites depending on the amount of BMAC needed. A bandage will be placed on the aspiration site.
Then the bone marrow is filtered to get rid of very tiny bone fragments and is transferred in sterile fashion into a special centrifuge tube. It is then centrifuged for two cycles to isolate the MSCs to make the final BMAC.
Now you’re ready to apply the BMAC to your injury. The skin at the injection site is numbed with a small needle and local anesthetic. Your provider will then precisely inject the BMAC into the injury site using ultrasound or fluoroscopic guidance.
Avoid NSAIDs like ibuprofen, as these suppress inflammation. Therefore, they counteract the effects of prolotherapy and most regenerative therapies. You may use acetaminophen for mild pain.
Avoid showering for 1 day and immersion in water for 3 days after your procedure. You may remove any bandages after 1 day.
Unless otherwise instructed, the treated body part should be used and slowly moved through its full range of motion after 3 days. It will be sore, but movement will not damage it. In fact it needs to move to heal!
For the next month, avoid specific activities that hurt you before treatment.
Exercise is vital to good health and finding a way to cross train around your injury is important not only for your physical health, but for your mental health as well. Your ROSM physician and physical therapist can help you with this.
Brief heat or ice therapy will not disrupt your regenerative therapy, but should not be used for more than 10 minutes.
Depending on the injury, physical therapy is started 2 to 4 weeks after injection. Gradual improvements in pain and function should be expected 8 to 12 weeks after injection.