What is Bone Marrow Cellular Concentrate Therapy?
Bone marrow cellular concentrate (BMCC) is a cutting-edge treatment for chronic sports and musculoskeletal injuries. It continued and expanded the revolutionary thinking of prolotherapists throughout the last half of the 20th century: that the body has the ability to heal itself when directed correctly. BMHCC adds to the arsenal of regenerative agents that began with prolotherapy and PRP, expanding the efficacy and range of conditions that can be treated with minimally invasive procedures. Professional and recreational athletes along with laypersons with degenerative pain conditions credit BMHCC treatment for enabling them to follow their passions. BMHCC is much less invasive than traditional surgeries for the same conditions, with much less downtime from work/play/sports.
Bone marrow contains at least 4 types of stem cells (mesenchymal, endothelial, hematopoietic, VSELs). We are often distracted by only the mesenchymal stem cells in the literature, however, the other type of stem cells play important roles such as morphing into mesenchymal stem cells with the right stimulus and helping to form new blood supple to injured/degenerative tissue. Though the stem cell fraction in bone marrow is relatively small, having the ability to concentrate it through simple lab procedures improves its potency. Having a source of stem cells in the injections drastically improves the efficacy of procedures and decreases the total number of times procedures need to be done. Stem cells act like the central organizers of the healing response, calling other cells and coordinating building of tissue and removal of damaged tissue.
First, we begin by preparing the patient for PRP creation as described in that section, as we always combine BMCC with PRP—this will augment the function of the stem cells in the marrow concentrate and help them to grow via the 13 different growth factors in PRP.
For patient preparation to do a bone marrow aspiration, first, we offer oral sedation to help create relaxation. Though far from a spa, we do have music, oxygen, and aromatherapy in our procedure room. A large volume of anesthetic is used to create anesthesia from the skin to the surface of the posterior pelvic bone, called the ilium. This is allowed to sit for several minutes to allow the anesthetic to reach full effect. A large needle, called a trocar, is inserted into the bone in approximately 3 locations on each side of the pelvis to slowly draw bone marrow. Small volumes from several locations yield more healing cells than a single large volume draw. The aspirated bone marrow is acquired in such a way that it has the least chance of clotting—which reduces yield.
A very unique feature at OrthoCure Clinic is that we measure the number of nucleated cells in the volume of fluid that we inject. We can vary this number based on location, the number of structures to treat, and the type of tissue to optimize healing. We believe this is a critical step, otherwise, there is no way to know how many cells are being “dosed” in your injections.
The entire treatment, from blood draw to solution preparation, to injection, takes 2-4 hours in the clinic, also a unique experience at OrthoCure Clinic. To prepare you, complete an arterial blood draw, complete a bone marrow aspiration, process your sample, measure your sample, create a final concentration for the injection and to do the procedures under both ultrasound and fluoroscopy takes time, patience and precision. We treat every procedure as if it was being done in an operating room.
Not All BMCC Is The Same!
Currently, there are over half a dozen companies making & selling commercial marrow concentrate preparation systems, of course with each company claiming that theirs is the best! Products can vary widely in terms of concentrations and what fraction of marrow you have compared to just blood. When OrthoCure Clinic was founded, we spent an extensive amount of time and money to optimize our marrow concentrate preparations. We invested in a cell counter and flow cytometry to prove the exact concentrations of nucleated cells as well as the presence of small circulating stem cells. The most common fraction of marrow that is acquired is called the buffy coat, however, we have devised methods to retain the healing cells from 2 other subfractions of bone marrow, optimizing the use of your sample. We invested in a centrifuge that has the horsepower to concentrate a protein called Alpha-2-Macroglobulin (A2M—a molecule that has been associated with cartilage repair) and had an outside lab validate that the protein was present in our samples.
We take all these steps to ensure that you receive a marrow concentrate product that is the absolute highest quality, purity, and effectiveness currently available.
BMCC treatment works best for arthritic conditions and torn/severely deteriorated tendons and ligaments, as well as fibrocartilage such as discs and meniscus that have failed other conservative treatment, including:
- Neck injuries such as whiplash, arthritis & chronic instability
- Rotator cuff injuries, including partial-thickness & full-thickness tears (up to 2.5 cm)
- Shoulder pain & instability
- Tennis & golfer’s elbow (severe/non-responsive cases)
- Wrist tendon & fibrocartilage (TFCC) injuries
- Hamstring & hip tendon degeneration (severe/non-responsive cases)
- Pubic symphysis injuries & instability (Athletic pubalgia)
- Knee sprains & instability, including partially torn ACLs
- Patellofemoral syndrome & patellar tendinosis
- Ankle sprains, tendon degeneration & instability
- Achilles tendinosis & plantar fasciitis (severe/non-responsive cases)
- Knee, hip, and other joint osteoarthritis
- Degenerated, torn and herniated discs
- Areas of bone degeneration in arthritic joints
- Non-healing fractures
- Areas of bone necrosis (death)
Bone Marrow Cellular Concentrate Therapy FAQs
This is one of the most common questions we receive—patients’ preconceived beliefs about bone marrow aspiration definitely comes with some trepidation. From widely spread local anesthetic to oral sedation, oxygen, aromatherapy, and music, we do the utmost to help you be comfortable. Dr. Hanson has done studies on the pain of bone marrow aspiration of 300 patients. 95% said the pain of the procedure was about or less than what they expected. Going slow and monitoring for your discomfort with adjustments is the primary means to ensure that bone marrow aspiration is as comfortable as possible.
The level of discomfort of the treatment depends in part on the area being treated. For example, injections into a joint often are minimally uncomfortable and in some cases painless. Injections into tendons and the capsules of joints tend to be more uncomfortable. Patients usually experience moderate pain for the next few days. In cases where large numbers of injections will be completed, Dr. Hanson will perform a regional nerve block to reduce pain during and after the injection whenever possible.
We also have a master Reiki practitioner who is available to perform energy healing before and after procedures.
We encourage you to have a person of support with you during the procedures, as long as they are not prone to fainting!
On average, most patients start to see signs of improvement with BMCC anywhere from 2-12 weeks after treatment. This improvement can be less overall pain, an ability to do more activity before pain sets in, and/or a faster recovery from pain.
Anytime a needle is placed anywhere in the body, even when getting blood drawn, there is a risk of infection, bleeding, and nerve damage. However, these are very rare. Other complications, though rare, can occur depending on the area being treated, and will be discussed by your doctor before starting treatment. Because BMCC uses your own blood, you will not experience an allergy to it.
Studies suggest an improvement of 80% or more, though some arthritic joints, namely the hip, do not respond as well. Some patients experience complete relief of their pain. In the case of tendon and ligament injuries, the results are generally permanent. In the case of joint arthritis, the length of the treatment depends partly on the severity of the condition. Mild arthritis may not need another round of treatments. More advanced arthritis, on the other hand, typically requires a repeat course of treatment, usually in 1-3 years.
The goal of these treatments is to reduce pain and to improve function. While there is some evidence that treatment occasionally does result in increased cartilage thickness, the important point to keep in mind is that the cartilage lining the joint surfaces has no pain fibers! For example, often we see patients with knee or hip arthritis where the joint that does NOT hurt has WORSE arthritis on x-ray! Pain from arthritis is very complex and involves far more than just how thick the cartilage is.
In the case of mild arthritis, the treatment may halt the development of further arthritic decay. However, in advanced arthritis, as noted above the goal of treatment is to reduce pain and improve function. In one large case series (wherein Dr. Hanson performed over half of the procedures), 90+% of patients who were told they needed knee replacement still had not done so 2 years from the time that BMCC treatment was used (1-3 procedures). In some cases, the arthritis is so severe that BMCC treatment is not a viable option initially. In such cases, Dr. Hanson will usually offer to work with you to improve the chemical niche first. If that is successful, a course of BMCC treatment may be warranted. Some patients are not surgical candidates because of other medical conditions. Other patients simply do not want joint replacement surgery under any circumstance. In these cases, BMCC may be a viable treatment option, but it is not a permanent solution in these specific situations. Treatments will need to be repeated periodically.