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BMAC Procedure

Bone Marrow Aspirate Concentrate (BMAC) is a promising regenerative therapy to help accelerate healing in moderate to severe osteoarthritis or tendon injuries.Similar to Platelet Rich Plasma (PRP), BMC harnesses the body's natural ability to heal itself by using regenerative cells found in a patient's own bone marrow. It is a more advanced form of regenerative therapy, in which blood is withdrawn from the patient's bone marrow and concentrated in a special device. Stem cells are collected by aspirating bone marrow from the posterior iliac crest. The bone marrow is a central compartment in all of your bones which produce red blood cells, white blood cells, and platelets, and has a large concentration of hematopoietic stem cells. Hematopoietic stem cells are responsible for creating vessels.

Unfortunately, as we mature with time, the quantity of regenerative cells declines. For example, as in infant, one in 10,000 cells is a regenerative cell versus one in 2,000,000 by the time we reach 70.

A cannulated needle is inserted into the bone area by tapping with a small gavel. Most procedures require about 2oz (60cc) of bone marrow aspirate which is suctioned with a manual syringe and then filtered of any small fragments. After filtration is complete the bone marrow aspirate concentrate (BMAC) is placed in a centrifuge to be spun for separation of stem cells. The final product is then inserted into the treated area along with the PRP.

There is usually minimal discomfort with the bone marrow aspirate, as the area is well anesthetized with lidocaine, a local anesthetic. All instruments are coated with heparin to prevent clotting and the procedure is conducted in a completely sterile area to prevent contamination. There is a brief moment of what is described often as an "unsettling" feeling right after the cannula is opened. This is due to the bone interior's initial contact with air, however it is not considered painful nor dangerous when done by a trained professional.

The BMAC concentrate contains a significant amount of stem cells and platelets, which are capable of regenerating tissues to a greater degree than the PRP. It is usually reserved for cases in which there is significant tissue damage. Sometimes, these grafts are enhanced with fibrin products necessary to create a tissue scaffold, in order to provide a tissue blueprint for regeneration.

Adipose

Adipose therapy is the extraction of fatty tissues for the harvesting of their stem cells. Fat compartments are a very rich source of stem cells, specifically mesenchymal stem cells which turn into cartilage, bone and ligaments.

The procedure can be compared to a smaller but simplified version of liposuction, since less fat is needed for the purposes of stem cell therapy. A cannulated needle is placed in either the stomach, hip or gluteal area. The area is anesthetized with lidocaine and injected with normal saline for better extraction of the adipose cells. The cannulated needle is attached to a negative pressurized tube for proper manual suctioning. The needle is placed just below the skin and motioned in and out. After the adipose cells have been extracted they will be set aside to allow for separation. Once the separation has occurred, the top layer, which contains the adipose and stem cells, will be washed and spun using the same procedure as was used with the bone marrow. The final concentrated stem cells obtained from your fat will be reintroduced to the injured area.

PRP

First, approximately one hour prior to patient’s scheduled PRP therapy, the patient’s blood is collected and then spun in a centrifuge specifically designed to concentrate platelets for PRP purposes. Second, topical and injected local anesthetic is provided to the affected region. Third, the needle is advanced in real time under musculoskeletal ultrasound (MSKUS) guidance, until the problem target site is reached. There is excellent visualization on MSKUS as the PRP flows into the affected region within 2mm proximity of the anatomical abnormality.

PRP heals the injured region, which is different from Cortisone shots.

Growth Factors are released from large quantities of activated platelets at the site of injury. This leads to an induced inflammatory reaction that initiates a powerful effective healing cascade. Growth factors stimulate blood flow, promote matrix formation which is the “groundwork” of all soft tissue, restore tendon and ligamentous proteins that may have been previously compromised, and “toughen up” cartilage to become more firm and resilient.

Most patients notice some element of improvement by 2-6 weeks after PRP. Symptom improvement is slow and subtle as days and weeks pass, with usual report of original pain being replaced with more of a soreness. “Good days” become more and “bad days” become less as time passes, with pain intensity dropping along the way. Increased endurance and strength are typically reported. Clinical trials are reporting ongoing improvement up to 6-9 months after PRP in some cases.

Insurance

No, this procedure is considered "experimental" by insurance companies currently.