Understanding bone safety zones during bone marrow aspiration from the iliac crest: the sector rule

Hernigou, Jacques; Picard, Laure; Alves, Alexandra; Silvera, Jonathan; Homma, Yasuhiro; Hernigou, Philippe

doi:10.1007/s00264-014-2343-9

Cited by 67 publications

(51 citation statements)

References 13 publications

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“…Aiming at achieving safe aspiration of the marrow, Hernigou et al [17] have developed the sector rule for BMA from the iliac crest, which he popularised as the concept of “safety zones”. They studied the anatomy of the iliac bone including the adjacent neurovascular elements that are susceptible to damage by the trocar when it is introduced into the iliac crest.…”

Section: Resultsmentioning

confidence: 99%

A systematic review of the concept and clinical applications of bone marrow aspirate concentrate in tendon pathology

Imam

Holton

Horriat

et al. 2017

SICOT-J

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Tendon pathologies are a group of musculoskeletal conditions frequently seen in clinical practice. They can be broadly classified into traumatic, degenerative and overuse-related tendinopathies. Rotator cuff tears, Achilles tendinopathy and tennis elbow are common examples of these conditions. Conventional treatments have shown inconsistent outcomes and might fail to provide satisfactory clinical improvement. With the growing trend towards the use of mesenchymal stem cells (MSCs) in other branches of medicine, there is an increasing interest in treating tendon pathologies using the bone marrow MSC. In this article, we provide a systematic literature review documenting the current status of the use of bone marrow aspirate concentrate (BMAC) for the treatment of tendon pathologies. We also asked the question on the safety of BMAC and whether there are potential complications associated with BMAC therapy. Our hypothesis is that the use of BMAC provides safe clinical benefit when used for the treatment of tendinopathy or as a biological augmentation of tendon repair. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist while preparing this systematic review. A literature search was carried out including the online databases of PubMed, EMBASE, ClinicalTrial.gov and the Cochrane Library from 1960 to the end of May 2015. Relevant studies were selected and critically appraised. Data from eligible studies were extracted and classified per type of tendon pathology. We included 37 articles discussing the application and use of BMAC for the treatment of tendon pathologies. The Critical Appraisal Skills Program (CASP) appraisal confirmed a satisfactory standard of 37 studies. Studies were sub-categorised into: techniques of extraction, processing and microscopic examination of BMAC (n = 18), where five studies looked at the evaluation of aspiration techniques (n = 5), augmentation of rotator cuff tears (n = 5), augmentation of tendo-achilles tendon (n = 1), treatment of gluteal tendon injuries (n = 1), management of elbow epicondylitis (n = 2), management of patellar tendinopathy (n = 1) and complications related to BMAC (n = 5). Multiple experimental studies investigated the use of BMAC for tendon repair; nonetheless, there are only limited clinical studies available in this field. Unfortunately, due to the scarcity of studies, which were mainly case series, the current level of evidence is weak. We strongly recommend further future randomised controlled studies in this field to allow scientists and clinicians make evidence-based conclusions.

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Section: Resultsmentioning

confidence: 99%

A systematic review of the concept and clinical applications of bone marrow aspirate concentrate in tendon pathology

Imam

Holton

Horriat

et al. 2017

SICOT-J

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“…Representing the largest population of WBCs in the circulation, polymorphonuclear leukocytes (PMNs or granulocytes) constitute the first line of phagocytic defense. Due to the relatively short life span of PMNs, the bone marrow continuously produces these phagocytes from haematopietic precursors to maintain homeostatic levels of circulating PMNs [33,40]. The existence of circulating progenitor cells in the peripheral blood of man was first documented by McKredie et al in 1971 [31].…”

Section: Discussionmentioning

confidence: 99%

“…These haemopoietic stem cells also circulate in the peripheral blood of humans [33]. In humans the total number of circulating granulocyte-macrophage colony-forming units (CFU-GM) in the peripheral blood is one-tenth to one-fiftieth that of bone marrow [33], and normally increases in case of infection [33]. A factor limiting the control of bacterial infection may be the inability to obtain sufficient quantities of granulocytes and macrophages precursors in the peripheral blood due to bone marrow failure following a severe trauma.…”

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confidence: 99%

“…However bone marrow also contains granulocytes and macrophages precursors [30][31][32] named as granulocytemacrophage colony-forming units (CFU-GM), both of which have a prophylactic action against infection. These haemopoietic stem cells also circulate in the peripheral blood of humans [33]. In humans the total number of circulating granulocyte-macrophage colony-forming units (CFU-GM) in the peripheral blood is one-tenth to one-fiftieth that of bone marrow [33], and normally increases in case of infection [33].…”

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confidence: 99%

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Local transplantation of bone marrow concentrated granulocytes precursors can cure without antibiotics infected nonunion of polytraumatic patients in absence of bone defect

Hernigou

Trousselier

Roubineau

et al. 2016

International Orthopaedics (SICOT)

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“…Pierini et al analyzed MSC yield from the posterior or anterior iliac crest and the subchondral knee sites and concluded that the posterior iliac crest was preferable although no differences were found for viability, phenotype, expansion kinetics or multilineage differentiation (13). Hernigou studied the risk of complications when harvesting from the iliac crest and determined that higher risks such as trocar contact with the external iliac artery were observed with aspiration in the four most anterior sections with a higher risk in women (16). Placement of the trocar deeper than 6 cm in the posterior iliac crest was at risk for sciatic nerve and gluteal vessel damage.…”

Section: Harvesting and Characterization Of Msc From Different Tissuesmentioning

confidence: 99%

Stem Cell Considerations for the Clinician

Hasty

Cho

2016

Physical Medicine and Rehabilitation Clinics of North America

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Summary While there is ample evidence that beneficial results can be obtained from the use of MSC, several questions regarding their use remain to be answered. A better definition is needed for the mechanism/s by which the MSC are eliciting the positive outcome of their use whether it lies in the paracrine factors that are made by the MSC that affect the innate or adaptive immunity or impact the metabolism of resident cells, or their contribution as precursor cells giving rise to more differentiated reparative cells. If paracrine effects are desirable, commercial sources of allogeneic MSC could provide an easily obtainable, well-characterized reagent for the clinician. In their function as reparative cells, the longevity and fate of allogeneic MSC needs to be further evaluated on longer-term basis. The use of autologous cells has both advantages and its own inherent disadvantages involving additional procedures for collection, preparation and characterization of the MSC. It is apparent that a critical number of MSC are necessary for an optimal outcome for implantation. It remains to be determined if tissues such as adipose tissue provide more MSC than bone marrow and if the capability for differentiation is equivalent. A better understanding is also needed for how individual patient factors such as age, sex, drug regimens and co-morbidities influence the MSC population. For many of these questions, preclinical models will be helpful, but the task of evaluating and implementing these findings for orthopaedic patients falls onto the shoulders of clinical researchers. Evaluation of these questions is a daunting, but such a challenge fits the concept of personalized medicine in today’s medicine.

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Understanding bone safety zones during bone marrow aspiration from the iliac crest: the sector rule

Abstract: Using the sector system, trocars can be directed away from neural and vascular structures and toward zones that are likely to contain larger bone marrow stock.

Cited by 67 publications

References 13 publications

A systematic review of the concept and clinical applications of bone marrow aspirate concentrate in tendon pathology

A systematic review of the concept and clinical applications of bone marrow aspirate concentrate in tendon pathology

Local transplantation of bone marrow concentrated granulocytes precursors can cure without antibiotics infected nonunion of polytraumatic patients in absence of bone defect

Stem Cell Considerations for the Clinician

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