Bone Grafting
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Percutaneous autologous bone-marrow grafting for nonunions-Surgical technique
Hernigou P, Mathieu G, Poignard A, et al. JBJS 2006;88-A:322-327
Summary: A technique for obtaining progenitor cells by iliac crest aspiration, concentrating the progenitor cells via centrifugation and reinjection of the concentrated progenitor cells into the site of a tibial fracture nonunion is described.
Quotation: "The effectiveness of this technique for the treatment of atrophic nonunions has been confirmed by several authors. However, the efficacy appears to be related to the number of progenitor cells in the graft."
The role and effectiveness of bone marrow in osseous regeneration
Block, JE. Medical Hypotheses 2005;65:740-747.
Summary: A review of the literature related to the osteogenic nature of bone marrow was undertaken. De novo bone formation in animal models, animal models in osseous sites, and human clinical studies were reviewed. The author concluded that bone marrow enriched grafting matrices almost uniformly produced superior results to bone marrow or the matrix alone.
Quotation: "While connective tissue progenitors are resident in many tissues, bone marrow serves as the richest and most readily available repository of progenitor cells capable of differentiating into mature bone forming cells."
Treatment of aneurysmal bone cysts by introduction of demineralized bone and autogenous bone marrow
Docquier PL, Delloye C. JBJS 2005;87-A(10):2253-2258.
Summary: 11 patients with primary aneurysmal bone cysts received a graft composite of demineralized bone and autologous bone marrow delivered through a small incision. At a mean follow-up duration of 3.9 years, healing was achieved in all eleven patients.
Quotation: "This minimally invasive method is able to promote the self-healing of a primary aneurysmal bone cyst. As no curettage is required, the proposed treatment avoids extensive surgery and blood loss and is convenient for the treatment of poorly accessible lesions such as those occurring in the pelvis."
The use of percutaneous autologous bone marrow transplantation in nonunion and avascular necrosis of bone
Hernigou P, Poignard A, Manicom O, et al. JBJS(Br) 2005;896-902.
Summary: The concept of using autologous bone marrow in the treatment of nonunion and osteonecrosis is reviewed. Techniques of percutaneous delivery of autologous bone marrow to nonunion and osteonecrotic sites are described. After reaching the conclusion that traditional bone marrow aspirate may not always have a sufficient concentration of progenitor cells, different methods to increase the number of progenitor cells from a bone marrow aspiration are reviewed.
Quotation: "This type of marrow transfer, or grafting, is a relatively simple procedure which is inexpensive and can be done on an outpatient basis."
Treatment of osteonecrosis of the femoral head with implantation of autologous bone-marrow cells. A pilot study
Gangji V, Hauzeur JP, Matos C, et al. JBJS 2004;86:1153-1160.
Summary: 13 patients (18 hips) with stage-I or II osteonecrosis of the femoral head were allocated to a treatment of either core decompression (control group) or core decompression with the implantation of autologous bone-marrow mononuclear cells (bone-marrow-graft group). At 24 months, the bone-marrow-graft group had a significant reduction in pain and joint symptoms. Five of the eight hips in the control group had deteriorated to stage III compared to only one of the ten hips in the bone-marrow-graft group.
Quotation: "Implantation of autologous bone-marrow mononuclear cells appears to be a safe and effective treatment for early stages of osteonecrosis of the femoral head."
Treatment of acute fractures with a collagen-calcium phosphate graft material. A randomized clinical trial
Chapman MW, Bucholz R, Cornell C. JBJS 1997;79:495-502.
Summary: A prospective, randomized trial of 213 patients (249 fractures) needing bone grafting for fractures of the long bone was performed at 18 clinical sites. Patients received either autogenous bone graft from the iliac crest or a calcium-phosphate ceramic, impregnated with autologous bone marrow aspirate. There were no significant differences between the two treatment groups with respect to rates of union or functional measures. Complication rates were similar between the groups except for infection, where a significantly higher rate was seen in the autogeneous bone graft group. The conclusion was that use of the composite graft material was justified on the grounds of safety, efficacy, and elimination of the increased operative time and risk involved in obtaining an autogenous graft from the iliac crest.