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Elattar O, Christophersen CM, Farber D. Pain and Complications Following Bone Marrow Aspirate Concentrate Harvested From the Iliac Crest in Foot and Ankle Surgery. Foot Ankle Spec 2024; 17:23-28. [PMID: 34142581 DOI: 10.1177/19386400211017379] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Autologous bone graft is the gold standard in orthopedics, with the iliac crest the most common harvest site. In an attempt to minimize morbidity with open bone graft harvest from the iliac crest and still maintain the benefit of collecting and transplanting live cells and growth factors, bone marrow aspirate concentrate (BMAC) from the iliac crest has become increasingly popular. However, any harvest procedure can potentially cause pain and complications. The purpose of this study was to evaluate the safety and complications of BMAC from the iliac crest for use in foot and ankle fusion procedures. METHODS A retrospective chart review was performed on all patients who underwent BMAC harvest from the iliac crest with their foot or ankle procedure by 1 of 4 fellowship-trained surgeons (2014-2017) with a minimum of 6-month follow-up. Patients were evaluated for complications, pain, and functional limitation secondary to the harvest. The final outcome follow-up was conducted using a specifically designed telephone questionnaire to assess patient satisfaction. A total of 55 patients were included, with a median age of 58 years (range 31-81 years) and 69% were women. RESULTS Out of 55 patients, 52 (94.5%) reported good to excellent results, and satisfaction with the procedure at the time of the questionnaire. Three patients reported persistent complications and some element of dissatisfaction after 6 months. Some patients reported transient complications (hematomas and numbness) that eventually resolved. Fifty percent of patients reported some element of immediate post-operative pain. However, at the time of final follow-up, only 2 reported persistent pain at the harvest site lasting up to 6 months, but it was not activity limiting. CONCLUSION BMAC harvest is a safe procedure with a high rate of patient satisfaction and minimal morbidity. LEVELS OF EVIDENCE Level IV: Case series.
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Affiliation(s)
- Osama Elattar
- Clinical Orthopedic Surgery, University of Toledo, Toledo, Ohio
| | | | - Daniel Farber
- Clinical Orthopedic Surgery, University of Pennsylvania Medicine, Philadelphia, Pennsylvania
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2
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Bi M, Yang K, Yu T, Wu G, Li Q. Cell-based mechanisms and strategies of co-culture system both in vivo and vitro for bone tissue engineering. Biomed Pharmacother 2023; 169:115907. [PMID: 37984308 DOI: 10.1016/j.biopha.2023.115907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 11/22/2023] Open
Abstract
The lack of a functional vascular supply has been identified as a major challenge limiting the clinical introduction of stem cell-based bone tissue engineering (BTE) for the repair of large-volume bone defects (LVBD). Various approaches have been explored to improve the vascular supply in tissue-engineered constructs, and the development of strategies that could effectively induce the establishment of a functional vascular supply has become a major goal of BTE research. One of the state-of-the-art methods is to incorporate both angiogenic and osteogenic cells in co-culture systems. This review clarifies the key concepts involved, summarises the cell types and models used to date, and systematically evaluates their performance. We also discuss the cell-to-cell communication between these two cell types and the strategies explored in BTE constructs with angiogenic and osteogenic cells to optimise their functions. In addition, we outline unresolved issues and remaining obstacles that need to be overcome for further development in this field and eventual successful repair of LVBD.
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Affiliation(s)
- Mengning Bi
- Department of Prosthetic Dentistry, Stomatological Hospital and Dental School of Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Shanghai, China; Department of Orthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology Shanghai, China
| | - Kaiwen Yang
- Department of Prosthetic Dentistry, Stomatological Hospital and Dental School of Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Shanghai, China; Department of Oral Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology &Shanghai Research Institute of Stomatology; National Clinical Research Center of Stomatology, Shanghai, China
| | - Tao Yu
- Department of Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Gang Wu
- Department of Oral and Maxillofacial Surgery/Pathology, Amsterdam UMC and Academic Center for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam (VU), Amsterdam Movement Science (AMS), Amsterdam, the Netherlands; Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam (UvA) and Vrije Universiteit Amsterdam (VU), Amsterdam, the Netherlands.
| | - Qiong Li
- Department of Prosthetic Dentistry, Stomatological Hospital and Dental School of Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Shanghai, China.
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3
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Lee W, Prat D, Chao W, Farber DC, Wang C, Wapner KL. The Efficiency of Highly Porous β-Tricalcium Phosphate With Bone Marrow Aspirate Concentrate in Midfoot Joint Arthrodesis. Foot Ankle Spec 2023:19386400231213177. [PMID: 38018529 DOI: 10.1177/19386400231213177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
BACKGROUND Nonunion is one of the most common and devastating complications following midfoot joint arthrodesis. Many different types of bone grafts and bone substitutes have been used to promote osseous fusion. However, there is no consensus on the gold standard bone grafting material and whether biologic materials should be used alone or in combination. The purpose of this study is to investigate the efficiency of highly porous β-tricalcium phosphate (β-TCP) with bone marrow aspirate concentrate (BMAC) in midfoot joint arthrodesis. METHODS This retrospective comparative study included patients who underwent midfoot joint arthrodesis using compression screws. Patients were classified into 2 groups: arthrodesis with highly porous β-TCP and BMAC (group A) and arthrodesis without them (group B). The osseous union rate was compared between the 2 groups. A total of 44 patients (46 feet) including 89 joints were included in this study. RESULTS There was a significant difference in the union rate between the 2 groups: 91.5% (43/47 joints) in arthrodesis with highly porous β-TCP and BMAC (group A) and 76.2% (32/42 joints) in arthrodesis without highly porous β-TCP and BMAC (group B; P = .048). CONCLUSION This study investigated the efficiency of highly porous β-TCP and BMAC to promote bony healing in midfoot joint arthrodesis. A significantly higher union rate was shown when arthrodesis was performed with highly porous β-TCP and BMAC, compared with arthrodesis performed without them. We suggest that highly porous β-TCP and BMAC can be a viable and effective adjunct to the fixation in midfoot joint arthrodesis. LEVEL OF EVIDENCE Level III: Retrospective comparative analysis.
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Affiliation(s)
- Wonyong Lee
- Division of Foot & Ankle Surgery, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Orthopaedic Surgery, Guthrie Medical Group, Sayre, Pennsylvania
| | - Dan Prat
- Division of Foot & Ankle Surgery, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Wen Chao
- Division of Foot & Ankle Surgery, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel C Farber
- Division of Foot & Ankle Surgery, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Carol Wang
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Keith L Wapner
- Division of Foot & Ankle Surgery, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
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4
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Sarpong NO, Swindell HW, Trupia EP, Vosseller JT. Republication of "Metatarsal Fractures". FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231193428. [PMID: 37566699 PMCID: PMC10408340 DOI: 10.1177/24730114231193428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023] Open
Affiliation(s)
- Nana O Sarpong
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Hasani W Swindell
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Evan P Trupia
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - J Turner Vosseller
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
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5
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AAOS Technology Overview Summary: Concentrated Bone Marrow Aspirate for Knee Osteoarthritis. J Am Acad Orthop Surg 2023; 31:e9-e13. [PMID: 36473210 DOI: 10.5435/jaaos-d-22-00228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 09/29/2022] [Indexed: 12/12/2022] Open
Abstract
The Concentrated Bone Marrow Aspirate (CBMA) for Knee Osteoarthritis Technology Overview is based on a systematic review of current scientific and clinical research. Through analysis of the current best evidence, this technology overview seeks to evaluate the efficacy of CBMA for patients with knee osteoarthritis. The systematic literature review resulted in 12 articles: three high-quality, four moderate-quality, and five low-quality. The findings of these studies were summarized to present findings on CBMA versus placebo and CBMA versus other treatment modalities. In addition, the work group highlighted areas for needed additional research when evidence proved lacking on the topic and carefully noted the potential harms associated with an intervention, required resource utilization, acceptability, and feasibility.
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Krasilnikova OA, Baranovskii DS, Yakimova AO, Arguchinskaya N, Kisel A, Sosin D, Sulina Y, Ivanov SA, Shegay PV, Kaprin AD, Klabukov ID. Intraoperative Creation of Tissue-Engineered Grafts with Minimally Manipulated Cells: New Concept of Bone Tissue Engineering In Situ. Bioengineering (Basel) 2022; 9:704. [PMID: 36421105 PMCID: PMC9687730 DOI: 10.3390/bioengineering9110704] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 07/22/2023] Open
Abstract
Transfer of regenerative approaches into clinical practice is limited by strict legal regulation of in vitro expanded cells and risks associated with substantial manipulations. Isolation of cells for the enrichment of bone grafts directly in the Operating Room appears to be a promising solution for the translation of biomedical technologies into clinical practice. These intraoperative approaches could be generally characterized as a joint concept of tissue engineering in situ. Our review covers techniques of intraoperative cell isolation and seeding for the creation of tissue-engineered grafts in situ, that is, directly in the Operating Room. Up-to-date, the clinical use of tissue-engineered grafts created in vitro remains a highly inaccessible option. Fortunately, intraoperative tissue engineering in situ is already available for patients who need advanced treatment modalities.
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Affiliation(s)
- Olga A. Krasilnikova
- Department of Regenerative Medicine, National Medical Research Radiological Center, Koroleva St. 4, 249036 Obninsk, Russia
| | - Denis S. Baranovskii
- Department of Regenerative Medicine, National Medical Research Radiological Center, Koroleva St. 4, 249036 Obninsk, Russia
- Research and Educational Resource Center for Cellular Technologies, Peoples’ Friendship University of Russia (RUDN University), Miklukho-Maklay St. 6, 117198 Moscow, Russia
| | - Anna O. Yakimova
- Department of Regenerative Medicine, National Medical Research Radiological Center, Koroleva St. 4, 249036 Obninsk, Russia
| | - Nadezhda Arguchinskaya
- Department of Regenerative Medicine, National Medical Research Radiological Center, Koroleva St. 4, 249036 Obninsk, Russia
| | - Anastas Kisel
- Department of Regenerative Medicine, National Medical Research Radiological Center, Koroleva St. 4, 249036 Obninsk, Russia
| | - Dmitry Sosin
- Federal State Budgetary Institution “Centre for Strategic Planning and Management of Biomedical Health Risks” of the Federal Medical Biological Agency, Pogodinskaya St. 10 Bld. 1, 119121 Moscow, Russia
| | - Yana Sulina
- Department of Obstetrics and Gynecology, Sechenov University, Bolshaya Pirogovskaya St. 2 Bld. 3, 119435 Moscow, Russia
| | - Sergey A. Ivanov
- Department of Regenerative Medicine, National Medical Research Radiological Center, Koroleva St. 4, 249036 Obninsk, Russia
| | - Peter V. Shegay
- Department of Regenerative Medicine, National Medical Research Radiological Center, Koroleva St. 4, 249036 Obninsk, Russia
| | - Andrey D. Kaprin
- Department of Regenerative Medicine, National Medical Research Radiological Center, Koroleva St. 4, 249036 Obninsk, Russia
- Research and Educational Resource Center for Cellular Technologies, Peoples’ Friendship University of Russia (RUDN University), Miklukho-Maklay St. 6, 117198 Moscow, Russia
| | - Ilya D. Klabukov
- Department of Regenerative Medicine, National Medical Research Radiological Center, Koroleva St. 4, 249036 Obninsk, Russia
- Research and Educational Resource Center for Cellular Technologies, Peoples’ Friendship University of Russia (RUDN University), Miklukho-Maklay St. 6, 117198 Moscow, Russia
- Obninsk Institute for Nuclear Power Engineering, National Research Nuclear University MEPhI, Studgorodok 1, 249039 Obninsk, Russia
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Lee W, MacDonald J, Prat D, Chao W, Farber DC, Wapner KL. Midfoot Joint Arthrodesis Using Compression Plate With Lag Screw Augmenting With Highly Porous β-Tricalcium Phosphate and Bone Marrow Aspirate Concentrate. Foot Ankle Spec 2022:19386400221123630. [PMID: 36214330 DOI: 10.1177/19386400221123630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is still a controversy regarding the most optimal fixation instruments and bone graft materials for midfoot joint arthrodesis. We present the results of midfoot joint arthrodesis using compression plate with lag screw augmenting with highly porous β-tricalcium phosphate (β-TCP) and bone marrow aspirate concentrate (BMAC). METHODS We performed a retrospective review of patients undergoing midfoot joint arthrodesis using compression plate with lag screw augmenting with highly porous β-TCP and BMAC from January 2014 to May 2019. The radiographic bony union rate was investigated. Postoperative complications and reoperations were also reviewed. A total of 36 patients (37 feet) including 75 joints were available in this study. RESULTS A high union rate was achieved as of 97.3% in 73 of 75 joints. Nonunion occurred in 2 patients including 2 joints. Other than nonunion, there were no major complications such as deep infection. Minor complications (5 of 75 joints, 6.7%) included hardware irritations. Reoperations were required in 1 patient for revision of arthrodesis and symptomatic hardware removal was performed in all 5 hardware irritation cases. CONCLUSION Based on our results, the fixation construct of compression plate with lag screw augmenting with highly porous β-TCP and BMAC is safe and effective for midfoot joint arthrodesis with an excellent union rate and a low complication rate. LEVEL OF EVIDENCE IV, retrospective case series.
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Affiliation(s)
- Wonyong Lee
- Division of Foot & Ankle Surgery, Department of Orthopaedic Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
- Department of Orthopaedic Surgery, Guthrie Medical Group, Sayre, Pennsylvania
| | - Justin MacDonald
- Department of Orthopaedic Surgery, Guthrie Medical Group, Sayre, Pennsylvania
| | - Dan Prat
- Division of Foot & Ankle Surgery, Department of Orthopaedic Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Wen Chao
- Division of Foot & Ankle Surgery, Department of Orthopaedic Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Daniel C Farber
- Division of Foot & Ankle Surgery, Department of Orthopaedic Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Keith L Wapner
- Division of Foot & Ankle Surgery, Department of Orthopaedic Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
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8
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Danilkowicz R, Murawski C, Pellegrini M, Walther M, Valderrabano V, Angthong C, Adams S. Nonoperative and Operative Soft-Tissue and Cartilage Regeneration and Orthopaedic Biologics of the Foot and Ankle: An Orthoregeneration Network Foundation Review. Arthroscopy 2022; 38:2350-2358. [PMID: 35605840 DOI: 10.1016/j.arthro.2022.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 04/07/2022] [Indexed: 02/02/2023]
Abstract
Orthoregeneration is defined as a solution for orthopaedic conditions that harnesses the benefits of biology to improve healing, reduce pain, improve function, and optimally, provide an environment for tissue regeneration. Options include drugs, surgical intervention, scaffolds, biologics as a product of cells, and physical and electromagnetic stimuli. The goal of regenerative medicine is to enhance the healing of tissue after musculoskeletal injuries as both isolated treatment and adjunct to surgical management, using novel therapies to improve recovery and outcomes. Various orthopaedic biologics (orthobiologics) have been investigated for the treatment of pathology involving the foot and ankle (including acute traumatic injuries and fractures, tumor, infection, osteochondral lesions, arthritis, and tendinopathy) and procedures, including osteotomy or fusion. Promising and established treatment modalities include 1) bone-based therapies (such as cancellous or cortical autograft from the iliac crest, proximal tibia, and/or calcaneus, fresh-frozen or freeze-dried cortical or cancellous allograft, including demineralized bone matrix putty or powder combined with growth factors, and synthetic bone graft substitutes, such as calcium sulfate, calcium phosphate, tricalcium phosphate, bioactive glasses (often in combination with bone marrow aspirate), and polymers; proteins such as bone morphogenic proteins; and platelet-derived growth factors; 2) cartilage-based therapies such as debridement, bone marrow stimulation (such as microfracture or drilling), scaffold-based techniques (such as autologous chondrocyte implantation [ACI] and matrix-induced ACI, autologous matrix-induced chondrogenesis, matrix-associated stem cell transplantation, particulated juvenile cartilage allograft transplantation, and minced local cartilage cells mixed with fibrin and platelet rich plasma [PRP]); and 3) blood, cell-based, and injectable therapies such as PRP, platelet-poor plasma biomatrix loaded with mesenchymal stromal cells, concentrated bone marrow aspirate, hyaluronic acid, and stem or stromal cell therapy, including mesenchymal stem cell allografts, and adipose tissue-derived stem cells, and micronized adipose tissue injections. LEVEL OF EVIDENCE: Level V, expert opinion.
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Affiliation(s)
- Richard Danilkowicz
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Christopher Murawski
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Manuel Pellegrini
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Markus Walther
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Victor Valderrabano
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Chayanin Angthong
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Samuel Adams
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A.
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9
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Ingall EM, Zhao J, Kwon JY. Revision Strategies for the Aseptic, Malaligned, Surgically Treated Ankle Fracture. Foot Ankle Clin 2022; 27:355-370. [PMID: 35680293 DOI: 10.1016/j.fcl.2021.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Although surgical fixation can take many forms depending on ankle fracture morphology, the goals of open reduction internal fixation are to restore fracture alignment, re-establish ankle stability, and achieve an anatomic mortise. A subset of patients may present postoperatively with evidence of suboptimal open reduction internal fixation. Increased contact pressures across the tibiotalar joint, increased talar shift, and pathologic joint loading leading to the development of post-traumatic arthritis are common sequela of the malaligned mortise. Treatment necessitates a comprehensive approach. This article describes our preferred systematic approach for diagnosis and treatment of the aseptic, malaligned, surgically treated ankle fracture.
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Affiliation(s)
- Eitan M Ingall
- Harvard Combined Orthopaedic Residency Program, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
| | - John Zhao
- Harvard Combined Orthopaedic Residency Program, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - John Y Kwon
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
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10
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Le HM, Stracciolini A, Stein CJ, Quinn BJ, Jackson SS. Platelet rich plasma for hallux sesamoid injuries: a case series. PHYSICIAN SPORTSMED 2022; 50:181-184. [PMID: 34346850 DOI: 10.1080/00913847.2021.1964006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Hallux sesamoid injuries are well described and can be debilitating and chronically disabling. The role of orthobiologics such as platelet-rich plasma (PRP) in sesamoid injuries has not been reported. This study describes three cases of recalcitrant hallux sesamoid injuries in teenage athletes who returned to impact activities, pain free, following one treatment of PRP. METHODS This is a case-series study describing three teenage athletes presenting to a tertiary level pediatric sports medicine practice with chronic hallux sesamoid injuries. RESULTS The three patients (two female, one male) described in this case series were 13-, 16-, and 17-year-old athletes. Their primary sports were ballet, basketball, and Irish step dance, respectively. All three athletes received PRP: two received unilateral treatment (one tibial sesamoid, one fibular sesamoid) and one received treatment to bilateral tibial sesamoids. The average duration of symptoms prior to PRP was 52.5 weeks (14-128 weeks). The average time out of their primary sport was 48.7 weeks (20-78 weeks). Three of the 4 sesamoids treated with PRP were tibial sesamoids. Each site of injury was treated with one treatment of leukocyte-rich PRP. All three athletes were cleared to return to impact activities such as running and jumping at 6-9 weeks following PRP, specifically 9 weeks after the final PRP injection for the patient who underwent bilateral treatments. CONCLUSION In the three cases provided of sesamoid injuries treated with PRP, the time to return to impact activities was less than reported for athletes not treated with PRP. Acknowledging that other management factors likely contributed to return to impact activities, this case series sets the groundwork for future research investigating the role of PRP with needle fenestration in the treatment of sesamoid injuries.
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Affiliation(s)
- Hung M Le
- Division of Sports Medicine, Orthopedics Department, Boston Children's Hospital, Boston, MA, USA
| | - Andrea Stracciolini
- Division of Sports Medicine, Orthopedics Department, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Cynthia J Stein
- Division of Sports Medicine, Orthopedics Department, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Bridget J Quinn
- Division of Sports Medicine, Orthopedics Department, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Sarah S Jackson
- Division of Sports Medicine, Orthopedics Department, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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11
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Scala VA, Kikuchi CK. Sesamoid Avascular Necrosis and Stress Fracture Treated with Core Decompression and Biologic Augmentation. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2022; 81:16-18. [PMID: 35340940 PMCID: PMC8941614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Sesamoid bone disorders are disabling conditions with limited treatment options. This case report describes a 17-year-old football player with avascular necrosis (AVN) in both the tibial and fibular hallux sesamoids with a concomitant non-displaced stress fracture of the tibial hallux sesamoid. After a short period of conservative management, the patient underwent open sesamoid core decompression with an application of concentrated bone marrow aspirate and amnion matrix. After postoperative physical therapy, the patient achieved a painless range of motion of the first metatarsophalangeal joint. He returned to full athletic activities by 6 months postoperatively. Core decompression with biologic augmentation is a viable treatment option for sesamoid AVN. Earlier surgical intervention for sesamoid AVN can also be considered, particularly in younger active patients.
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Affiliation(s)
- Victoria A. Scala
- Division of Orthopaedic Surgery, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
| | - Christian K. Kikuchi
- Division of Orthopaedic Surgery, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
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12
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Fletcher AN, Johnson AH. Biologic Adjuvants for Foot and Ankle Conditions. OPER TECHN SPORT MED 2021. [DOI: 10.1016/j.otsm.2021.150851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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13
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Glenn R, Johns W, Walley K, Jackson JB, Gonzalez T. Topical Review: Bone Marrow Aspirate Concentrate and Its Clinical Use in Foot and Ankle Surgery. Foot Ankle Int 2021; 42:1205-1211. [PMID: 34219485 DOI: 10.1177/10711007211021017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Bone marrow aspirate concentrate (BMAC) is now commonly used in orthopedic surgery. Animal studies showed promising results for cartilage, bone, and soft tissue healing; however, many of these outcomes have yet to be translated to human models. While there has been an increase in the use of BMAC in foot and ankle procedures, the associated clinical evidence is limited. The purpose of this review is to analyze the existing literature in order to evaluate the safety and efficacy of BMAC in foot and ankle surgery.
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Affiliation(s)
- Rachel Glenn
- Department of Orthopaedic Surgery, Prisma Health Richland Hospital/University of South Carolina, Columbia, SC, USA
| | - William Johns
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Jefferson Health, Philadelphia, PA, USA
| | - Kempland Walley
- Department of Orthopaedic Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - J Benjamin Jackson
- Department of Orthopaedic Surgery, Prisma Health Richland Hospital/University of South Carolina, Columbia, SC, USA
| | - Tyler Gonzalez
- Department of Orthopaedic Surgery, Prisma Health Richland Hospital/University of South Carolina, Columbia, SC, USA
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14
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Reamer-irrigator-aspirate versus bone marrow aspirate concentrate for osteoprogenitor cell retention and osteoinductive protein release on cancellous bone. J Orthop 2021; 27:13-16. [PMID: 34434001 DOI: 10.1016/j.jor.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/08/2021] [Indexed: 11/20/2022] Open
Abstract
Bone defects often require operative intervention with the use of bone graft. Two sources of autologous bone graft include reamer-irrigator-aspirate (RIA) and bone marrow aspirate concentrate (BMC). Osteoprogenitor cells and osteoconductive proteins have been identified in both sources. This study collected samples of these cells and proteins from a canine model and cultured them on human cancellous allograft bone blocks. Findings suggest that BMC may be preferred for indications that allow for delivery via injection, saturation of the patient's tissues, or an implanted scaffold, whereas RIA may be preferred when the biologic augment is delivered as a scaffold or graft.
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Gupta R, Rao R, Johnston TR, Uong J, Yang DS, Lee TQ. Muscle stem cells and rotator cuff injury. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:186-193. [PMID: 37588948 PMCID: PMC10426486 DOI: 10.1016/j.xrrt.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
The incidence of reinjury after treatment of rotator cuff tears (RCTs) remains very high despite the variety of nonoperative treatments and the high volume of surgical interventions performed. Muscle stem cells (MuSCs), also known as satellite cells, have risen to the forefront of rotator cuff tear research as a potential adjuvant therapy to aid unsatisfactory surgical outcomes. MuSCs are adult stem cells exhibiting the capacity to proliferate and self-renew, both symmetrically and asymmetrically. As part of this niche, they have been shown to adopt an activated phenotype in response to musculoskeletal injury and decrease their cellular populations during aging, implicating them as key players in both pathologic and normal physiological processes. While commonly connected to the regenerative phase of muscle healing, MuSCs also have the potential to differentiate into adverse morphologies. For instance, if MuSCs differentiate into adipocytes, the ensuing fatty infiltration serves as an obstacle to proper muscle healing and has been associated with the failure of surgical management of RCTs. With the potential to both harm and heal, we have identified MuSCs as a key player in RCT repair. To better understand this dichotomy, the following review will identify key studies regarding the morphology, function, and behavior of MuSCs with respect to RCTs and healing.
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Affiliation(s)
- Ranjan Gupta
- Department of Orthopaedics, University of California, Irvine, CA, USA
| | - Rohan Rao
- Department of Orthopaedics, University of California, Irvine, CA, USA
| | - Tyler R. Johnston
- Department of Orthopaedics, University of California, Irvine, CA, USA
| | - Jennifer Uong
- Department of Orthopaedics, University of California, Irvine, CA, USA
| | - Daniel S. Yang
- Department of Orthopaedics, University of California, Irvine, CA, USA
| | - Thay Q. Lee
- Congress Medical Foundation, Pasadena, CA, USA
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Sundet M, Johnsen E, Eikvar KH, Eriksen ML. Retrograde nailing, trabecular metal implant and use of bone marrow aspirate concentrate after failed ankle joint replacement. Foot Ankle Surg 2021; 27:123-128. [PMID: 32273230 DOI: 10.1016/j.fas.2020.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 03/04/2020] [Accepted: 03/06/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Ankle fusion after removal of alloplasty is known to be a procedure with a high potential for non-unions and poor function, especially tibio-talo-calcaneal fusion. We wanted to review our results after using a novel method for the procedure, combining retrograde nailing with a trabecular metal implant and bone marrow aspirate concentration applied in an ostoconductive pad in addition to autologous bone grafting. MATERIALS AND METHODS Retrospective review of a patient series, with some prospectively registered data. 31 ankles in 30 patients were operated from January 2016 to February 2019. RESULTS There were two non-unions (6.5%), and one delayed union, none of these were reoperated. The mean postoperative Manchester-Oxford Foot and Ankle Questionnaire score (MOxFQ) was 33.6 points. 9 patients scored an average MOxFQ at 72.9 immediately before surgery, while at follow-up this had decreased to 36.2, an improvement of 36.7 points (95% CI 18.3-54.9). There were 1 minor infection and 5 possible nerve injuries. One patient had the leg amputated 1 year after the surgery due to a non-related necrotizing fasciitis. CONCLUSION We present reasonably good short to medium term patient satisfaction and fusion rates with this novel combination of techniques.
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Affiliation(s)
- Mads Sundet
- Consultant Foot and Ankle Surgeon, Diakonhjemmet Hospital, Oslo, Norway.
| | - Elena Johnsen
- Consultant Radiologist, Diakonhjemmet Hospital, Oslo, Norway.
| | - Kari Helene Eikvar
- Department of Professional Affairs,The Norwegian Medical Association, Oslo, Norway.
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Hogan MV, Scott DM, Canton SP, LaBaze D, Yan AY, Wang JHC. Biologic therapies for foot and ankle injuries. Expert Opin Biol Ther 2020; 21:717-730. [PMID: 33382002 DOI: 10.1080/14712598.2021.1866534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: The use of orthobiologics as supplemental treatment for foot and ankle pathologies have increased in the past decades. They have been used to improve the healing of bone and soft tissue injuries. There have been several studies that examined the use of biologics for knee and hip pathologies but the foot and ankle construct has unique features that must be considered.Areas covered: The biologics for foot and ankle injuries that are covered in this review are platelet-rich plasma (PRP), stem cells, growth factors, hyaluronic acid, bone grafts, bone substitutes, and scaffolds. These modalities are used in the treatment of pathologies related to tendon and soft tissue as well as cartilage.Expert opinion: The utilization of biological adjuncts for improved repair and regeneration of ankle injuries represents a promising future in our efforts to address difficult clinical problems. The application of concentrated bone marrow and PRP each represents the most widely studied and commonly used injection therapies with early clinical studies demonstrating promising results, research is also being done using other potential therapies such as stem cells and growth factors; further investigation and outcome data are still needed.
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Affiliation(s)
- MaCalus V Hogan
- Departments of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.,Foot and Ankle Injury Research Center, University of Pittsburgh, Pittsburgh, PA, USA.,Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Devon M Scott
- Departments of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Stephen P Canton
- Departments of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Dukens LaBaze
- Departments of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Alan Y Yan
- Departments of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.,Foot and Ankle Injury Research Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - James H-C Wang
- Departments of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.,Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Abstract
Use of orthobiologics in sports medicine and musculoskeletal surgery has gained significant interest. However, many of the commercially available and advertised products are lacking in clinical evidence. Widespread use of products before fully understanding their true indications may result in unknown adverse outcomes and may also lead to increased health care costs. As more products become available, it is important to remain judicial in use and to practice evidence-based medicine. Likewise, it is important to continue advances in research in hopes to improve surgical outcomes. This article reviews clinical evidence behind common orthobiologics in the treatment of foot and ankle pathology.
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Affiliation(s)
- Nana O. Sarpong
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Hasani W. Swindell
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Evan P. Trupia
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - J. Turner Vosseller
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
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20
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Zhao E, Carney D, Chambers M, Ewalefo S, Hogan M. The role of biologic in foot and ankle trauma-a review of the literature. Curr Rev Musculoskelet Med 2018; 11:495-502. [PMID: 30054808 DOI: 10.1007/s12178-018-9512-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW The use of biologics in orthopedics is becoming increasingly popular as an adjuvant in healing musculoskeletal injuries. Though many biologics involved in the management of foot and ankle injuries are used based on physician preference, reports of improved outcomes when combined with standard operative treatment has led to further clinical interest especially in foot and ankle trauma. RECENT FINDINGS The most recent studies have shown benefits for biologic use in patients predisposed to poor bone and soft tissue healing. Biologics have shown benefit in treating soft tissue injuries such as Achilles ruptures as well as the complications of trauma such as non-unions and osteoarthritis. Biologics have shown some benefit in improving functional and pain scores, as well as reducing time to heal in foot and ankle traumatic injuries, with particular success shown with patients that have risk factors for poor healing. As the use of biologics continues to increase, there is a need for high-level studies to confirm early findings of lower level reports.
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Affiliation(s)
- Emily Zhao
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Suite 1011, Pittsburgh, PA, 15213, USA
| | - Dwayne Carney
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Suite 1011, Pittsburgh, PA, 15213, USA
| | - Monique Chambers
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Suite 1011, Pittsburgh, PA, 15213, USA
| | - Samuel Ewalefo
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Suite 1011, Pittsburgh, PA, 15213, USA
| | - MaCalus Hogan
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Suite 1011, Pittsburgh, PA, 15213, USA.
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Early Clinical Outcomes of Intra-Articular Injections of Bone Marrow Aspirate Concentrate for the Treatment of Early Osteoarthritis of the Hip and Knee: A Cohort Study. PM R 2018; 10:1353-1359. [PMID: 29857166 DOI: 10.1016/j.pmrj.2018.05.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 04/21/2018] [Accepted: 05/13/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Bone marrow aspirate concentrate (BMC) is one of the few cell-based therapies available as a possible biological treatment for early osteoarthritis (OA). Its efficacy, safety, and benefit compared with other treatments are still to be determined. OBJECTIVE To assess the clinical outcomes of patients undergoing intra-articular injection of BMC for the treatment of early knee and hip OA. DESIGN Prospective, cohort study. SETTING Single institution, quaternary level of care. PATIENTS Nineteen patients (16 female and 3 male), totaling 25 joints (10 knees, 15 hips), treated with intra-articular BMC for early OA between 2014 and 2016. The mean age at time of the procedure was 58 ± 12.7 years (range, 30-80 years). The mean follow-up was 13.2 ± 6.3 months (range, 6-24 months). Inclusion criteria included ≥18 years; knee OA, Kellgren-Lawrence grade I-II; hip OA, Tönnis grade I-II; first-time intra-articular BMC therapy, after unsuccessful symptomatic and conservative treatments (ie, physical therapy, analgesics and anti-inflammatory drugs) for 6 months. Exclusion criteria included pregnancy; malignancy; rheumatologic diseases; infection; Kellgren-Lawrence grade III-IV; Tönnis grade III; and previous intra-articular injections or surgery. INTERVENTIONS All patients had autologous bone marrow aspirate harvested from the iliac crest and centrifuged to achieve BMC, for intra-articular injection. MAIN OUTCOME MEASUREMENTS The hypothesis was formulated before the study. Patient-reported outcomes measures were assessed preoperatively and at last follow-up using the Western Ontario and McMaster Universities Arthritis Index. RESULTS Western Ontario and McMaster Universities Arthritis Index improved from a baseline of 40.8 ± 18.3% to 20.6 ± 17% (P < .001) at final follow-up. The satisfaction rate was 63.2%. The minimal clinically important difference threshold of 9.15 points was reached by 64% of the patients. Two patients were converted to total hip arthroplasty at 8 months after BMC injection. CONCLUSIONS Intra-articular injections of BMC for the treatment of early knee or hip OA were safe and demonstrated satisfactory results in 63.2% of patients. Future studies are necessary to determine the efficacy of this technique and its safety profile. LEVEL OF EVIDENCE II.
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Cottom JM, Plemmons BS. Bone Marrow Aspirate Concentrate and Its Uses in the Foot and Ankle. Clin Podiatr Med Surg 2018; 35:19-26. [PMID: 29156164 DOI: 10.1016/j.cpm.2017.08.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Bone marrow aspirate has been used for the adjunctive treatment of numerous pathologic conditions in orthopedics. Viable cells are found in aspiration from many different anatomic regions of the body. Concentration of these cells has been shown to improve healing due to the increased number of certain important cells. This article discusses the mechanisms involved and reviews the literature.
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Affiliation(s)
- James M Cottom
- Florida Orthopedic Foot & Ankle Center, 2030 Bee Ridge Road, Suite B, Sarasota, FL 34239, USA.
| | - Britton S Plemmons
- Florida Orthopedic Foot & Ankle Center, 2030 Bee Ridge Road, Suite B, Sarasota, FL 34239, USA
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