How to Manage Bone Marrow Aspirate Concentrate to Treat Musculoskeletal Disorders: A Systematic Review

Transcription

1 How to Manage Bone Marrow Aspirate Concentrate to Treat Musculoskeletal Disorders: A Systematic Review Diego Costa Astur, Elton Luiz B. Cavalcante, Adilson Góes R. Júnior, Pedro Debieux, João Victor Novaretti, Camila Cohen Kaleka, Moises Cohen

2 CONFLICT OF INTEREST Diego Costa Astur, Elton Luiz B. Cavalcante, Adilson Góes R. Júnior, Pedro Debieux, João Victor Novaretti, Camila Cohen Kaleka, Moises Cohen The authors declare no financial conflicts to diclosure

3 INTRODUCTION Bone Marrow Aspirate Concentrate - BMAC: Bone marrow components derived from distinct cellular origins; Concentrated through centrifugation (minimal separation); Potential advantages: Self-renewal; Differentiation to numerous tissues; Cell migration to injured tissue; Modulation of inflammatory process.

4 PURPOSE To help establish the optimal collection and processing method, as well as explore the efficacy of BMAC to treat musculoskeletal disorders in humans.

5 METHODS A search was carried out in 2018 by two independent reviewers: PubMed, Lilacs and Cochrane. The Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) checklist was used; Levels of evidence classification: Grading System of Recommendations Assessment, Development and Evaluation (GRADE) and Oxford Center for Evidence-Based Medicine.

6 METHODS Inclusion criteria: o Last 5 years; o Full text; o English written; o Humans Non Inclusion criteria o Evidence Level IV; o In vitro studies; o Revision articles. Extracted data included: production process, the site of acquisition, pathologies eligible for treatment, as well as the outcomes and effectiveness of the treatment.

7 Selected Articles: 333 Bone Marrow Aspirate Concentrate Excluded Articles: Did not use human subjects; - Did not mention musculoskeletal disorders; - Without mention of orthopedic use; - More than 5 years since publication; - Used animal subjects. Included Articles: 69 Selected Articles: 16 Duplicate Articles: 3 Excluded Articles: 51-19: low levels of evidence; - 25: mentioned, but without orthopedic use; - 4: full article not available; - 4: mentioned, but whitout; use in humans; - 1: review in progress. Reviewed Articles: 13

8 RESULTS 13 reviewed articles 10 from the last 2 years; 354 patients; Age: years; 5 studies were classified as level of evidence I (Oxford); Major pathologies: Osteochondral lesions; Femoral head osteonecrosis.

9 RESULTS Site and Quantity of Bone Marrow Aspirate: Anterior region of the iliac crest and 50 to 400 ml. Aspiration Technique: access incisions ranged from 3 to 10 cm, under either anesthesia; 3 to 10 aspirations (2 mm between punctures sites); 5 ml per aspiration; Syringes of 60 ml with anticoagulant and 11 mm needles.

10 RESULTS Processing Methodology: Centrifuge: Arteriocyte Magellan e Harvest SmartPreP 2 ; Speed: rpm; Time: 15 min; Final volume of processed: 12 to 50 ml; Applied volume: 5 50 ml; Application: immediately following processing.

11 RESULTS Review findings: Osteochondral lesions on the Knee: The articular cartilage resembled native conformation; Clinical and functional scores improvement; Lower risk of graft failure; Durable chondral repair when compared to microfractures. Femoral head osteonecrosis and Spinal arthrodesis: Without differences. Tibial pseudoarthrosis: Greater potential for consolidation; In infected pseudoarthrosis, the infectiot was treated without antibiotics. Partial rotator cuff tears: Increased proliferation ans cell migration to the injury

12 CONCLUSION Iliac Crest main place of aspiration; 60 ml syringe containing anticoagulant and 11 mm needle; Total volume aspirated between 50 and 60 ml; Centrifugation for 15 min (3200 rpm); Final volume applied from 5 to 6 ml.

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