Bone marrow aspirate clot: A feasible orthobiologic

Abstract

Musculoskeletal disorders are one of the major health burdens and a leading source of disability worldwide, affecting both juvenile and elderly populations either as a consequence of ageing or extrinsic factors such as physical injuries. This condition often involves a group of locomotor structures such as the bones, joints and muscles and may therefore cause significant economic and emotional impact. Some pharmacological and non-pharmacological treatments have been considered as potential solutions, however, these alternatives have provided quite limited efficacy due to the short-term effect on pain management and inability to restore damaged tissue.The emergence of novel therapeutic alternatives such as the application of orthobiologics, particularly bone marrow aspirate (BMA) clot, have bestowed medical experts with considerable optimism as evidenced by the significant results found in numerous studies addressed in this manuscript. Although other products have been proposed for the treatment of musculoskeletal injuries, the peculiar interest in BMA, fibrin clot and associated fibrinolytic mechanisms continues to expand.BMA is a rich source of various cellular and molecular components which have demonstrated positive effects on tissue regeneration in many in vitro and in vivo models of musculoskeletal injuries. In addition to being able to undergo self-renewal and differentiation, the hematopoietic and mesenchymal stem cells present in this orthobiologic elicit key immunomodulatory and paracrine roles in inflammatory responses in tissue injury and drive the coagulation cascade towards tissue repair via different mechanisms.Although promising, these complex regenerative mechanisms have not yet been fully elucidated.

Two Hits for Bone Regeneration in Aged Patients: Vertebral Bone Marrow Clot as a Biological Scaffold and Powerful Source of Mesenchymal Stem Cells

“…Thanks to its properties, the BMA clot behaves like an early hematoma, able not only to deliver new cells to the injury site but also to trigger an immunomodulatory cascade capable of attracting peripheral MSCs to the injury site. Nevertheless, to date, no studies evaluated the potential effects that aging could have on BMA clot biological properties ( Santos Duarte Lana et al, 2020 ). Since aging is accompanied by the increased incidence of bone diseases and reduced fracture-healing capacity, it is of key importance to evaluate orthobiologics’ properties in the aging population.…”

“…These data were also confirmed by an in vivo study by Lim and colleagues that underlined that the therapeutic potential of autologous bone graft and BMA clot in the repair of ulnar defects are similar, with the advantage of BMA clot being associated with a lower risk of complications ( Lim et al, 2019 ). A recent literature review further elucidates the characteristics found in BMA clot and its application in the clinical scenario ( Santos Duarte Lana et al, 2020 ). In this context, to confirm and strengthen data on the clinical use of BMA clot for bone regeneration, a pilot clinical study on clotted vertebral BMA is ongoing at our institution (Protocol: CVOD.…”

Bone Marrow Aspirate Matrix: A Convenient Ally in Regenerative Medicine

“…The use of anatomic landmarks for the average patient and ultrasound guidance for larger individuals may also be recommended. For the average patient, an ideal volume between 90 and 120 milliliters should be drawn, whereas in a large individual, volumes greater than 120–150 mL should be avoided [ 31 , 32 ].…”

“…Thinking critically, adding too many chemicals or exogenous products to the BMA product might interfere in its natural biological potential. Additionally, in order to cause coagulation, platelet degranulation is a required step; this step delivers numerous osteotropic cytokines and growth factors into the site of injury [ 32 ]. Another fundamental effect that is often overlooked is the fibrinolytic activity.…”

“…For the average patient, an ideal volume between 90 and 120 milliliters should be drawn, whereas in a large individual, volumes greater than 120-150 mL should be avoided [31,32].…”