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Bone Marrow Concentrate (BMC), a regenerative therapy for bone and joint injuries

Bone Marrow Concentrate (BMAC)

What is Bone Marrow Concentrate (BMC) therapy?

Bone Marrow Concentrate (BMC) Therapy, also known as Bone Marrow Aspirate Concentrate (BMAC) Therapy, is a promising cutting-edge regenerative therapy to help accelerate healing in moderate-to-severe osteoarthritis and tendon injuries and ligament injuries.

How does BMC therapy work?

BMC utilizes regenerative cells that are contained within a patient’s bone marrow. The marrow contains a rich reservoir of “pluripotent” stem cells that can be withdrawn from the patient’s Iliac bone and used for the procedure. Unlike other cells of the body, stem cells are “undifferentiated”, meaning they are able to replicate themselves into various types of tissue when injected into the target tissues. Also like Platelet Rich Plasma (PRP), BMC has an ability to harness the body’s healing mechanism through the aid of growth factors.

What is BMC therapy?

BMC therapy is a promising non-surgical, regenerative treatment used to treat various orthopedic injuries, including moderate-to-severe osteoarthritis, tendon injuries, and ligament injuries. BMC is a concentrate of regenerative stem cells obtained from a patient’s own bone marrow. The clinician removes a small amount (50 to 60ml) of the patient’s bone marrow and spins it in a centrifuge in order to generate a powerful concentrate that is injected into the injured area. In the past, these types of cells were often very difficult and expensive to obtain from the body. With recent medical advancements, the cells can be easily obtained and the procedure can be done with minimal discomfort under local anesthesia. The procedure can be completed as an outpatient or day care procedure.

Is removing bone marrow or the injection procedure very painful?

Bone marrow is aspirated under local infiltrative anesthesia. While there is some slight discomfort, most patients tolerate the procedure very well and with minimal pain. The procedure is done under local anesthesia to minimize any discomfort. Post-injection soreness at the injection site is sometimes present because of an inflammatory response caused by BMC Therapy. This soreness usually resolves on its own within a few days after the injection.

Why use BMC?

Unlike other cells of the body, bone marrow cells are “undifferentiated”, which means they have the ability to replicate themselves into a variety of tissue types when injected into the target tissues. When an injury occurs, the usual number of regenerative cells needed for tissue regeneration is often inadequate. With BMC, the concentrate of regenerative cells provides a more robust healing of the damaged tissue and aids in growth and repair by accelerating the body’s natural healing mechanism. While the full benefits of BMC are still unknown, it is found to reduce swelling, relieve pain, and enhance the healing of articular cartilage and bone.

What conditions are treated with BMC?

Based on current research and clinical experience, moderate-to-severe cases of osteoarthritis, tendon injuries, and ligament injuries show promising results. Numerous conditions can be considered for treatment with BMC.

  • Knee Pain: Osteoarthritis, Meniscus Tears (Medial, Lateral), Chondromalacia Patella, tendon injuries (Patellar Tendonitis, Quad Tendon), ligament sprains or tears (MCL, LCL, ACL)
  • Hip Pain: Osteoarthritis, Hip Labrum Tears, SI Joint Dysfunction, Piriformis Syndrome, Greater Trochanteric Bursitis, Iliotibial Band (ITB) Syndrome
  • Shoulder: Osteoarthritis, Rotator Cuff Tendinitis, Tendonopathy, or Partial Tears, Labrum Tear, Bicipital Tendinitis
  • Elbow Pain: Lateral Epicondylitis (Tennis Elbow), Medial Epicondylitis (Golfer’s Elbow)
  • Wrist/Hand Pain: Osteoarthritis, DeQuervain’s Tenosynovitis
  • Ankle & Foot Pain: Achilles Tendinitis or Partial Tears, Plantar Fasciitis, Ankle sprains/ligament injury
  • Spine: Facet Joint Arthropathy. Sacroiliac (SI) Joint Dysfunction

 

How long does it take for BMC to “work”?

Most patients notice some level of improvement by 2-6 weeks following BMC. Increased stability and strength are typically reported along with the decrease in pain. A second level of benefits may be obtained between 6 weeks and 3 months. Patients are encouraged to remain active with a functional rehabilitation program and strengthen surrounding muscles during this period.

Regenerative Therapy of Bone & Joint Diseases

What is the difference between PRP (Platelet Rich Plasma) and BMC?

In general, PRP may be more appropriate for mild-to-moderate osteoarthritis or tendon injuries. BMC may be reserved for more challenging cases such as moderate-to-severe osteoarthritis or when more potent effects are desired.

How is the treatment performed and administered?

The process is relatively simple. The area of extraction is locally numbed so no pain is felt. Bone marrow is extracted from the patient’s pelvic bone from an area called the Iliac crest.

A suctioned syringe attached to a long needle is used to reach the Iliac crest bone under local infiltrative anesthesia. The collected sample is transferred through a filter then placed in a centrifuge for spinning. Spinning at a high speed separates the platelets and stem cells from the bone marrow sample. The concentration of stem cells and healing components, collectively known as the bone marrow concentrate, are reintroduced into the target joints or to the injured area under ultrasound guidance. The entire process takes approximately 2 hours and patients go home the same day.

Is BMC curative or just a temporary treatment?

BMC targets the root of the problem and attempts to heal the tissue and thus heals the disease.

How many treatments are needed?

Most patients require only a single BMC treatment when the degree of the injury is less. However, in challenging cases, if a patient experiences significant relief that plateaus, they may consider a second BMC injection, months later.

How quickly can the patient get back to his or her regular routine?

For the first 2-3 days, swelling and discomfort are typical in the injected area. By the end of the first week, these symptoms usually begin to resolve and physical therapy is started to optimize BMC effects and facilitate recovery.

Are there any contraindications (i.e. exclusion criteria) that would inhibit one from getting BMC?

BMC therapy is contraindicated in certain cases such as bone marrow-derived cancer (such as lymphoma), non-bone marrow-derived cancer or metastatic disease (should be checked with oncologist), and active systemic infection. Blood-thinning medications must be discontinued or managed appropriately.

Is BMC covered under insurance?

No. While there are currently several publications in peer-reviewed medical journals showing the positive effects of BMC therapy on the tendon, soft tissue, and cartilage injuries, BMC is still not covered by insurance companies at this time.

About Author –

Dr. Krishna Subramaniyam, Consultant Orthopedic Surgeon, Yashoda Hospital, Hyderabad. His expertise include Arthritis Management and Joint replacement surgeries, Sports injuries management and arthroscopic surgeries for Knee, Shoulder and Hip

 

Dr. Krishna Subramaniyam

MS(Ortho), PDCR, Ph.D
Consultant Orthopedic Surgeon
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