Bone marrow aspirate concentrate Prolotherapy
Bone Marrow Prolotherapy refers to the use of bone marrow concentrate injections into areas of degenerative joint disease to stop and repair degenerative changes. The use of bone marrow aspirate relies on the action of stem cells to initiate and guide this repair.
Doctors at the Mayo Clinic and Yale University are among the first to get 2017 research out on the benefits of Bone Marrow Aspirate Concentrate for Knee Osteoarthritis. Here is the summary of that research:
- Bone marrow aspirate concentrate (BMAC) is increasingly used as a regenerative therapy for musculoskeletal pathological conditions despite limited evidence-based support.
- HYPOTHESIS: BMAC will prove feasible, safe, and efficacious for the treatment of pain due to mild to moderate degenerative joint disease of the knee.
In their single-blind, placebo-controlled trial, 25 patients with bilateral knee pain from bilateral knee osteoarthritis were randomized to receive BMAC into one knee and saline placebo into the other.
Early results show that BMAC is safe to use and is a reliable and viable (stem cell) cellular product. Study patients experienced a similar relief of pain in both BMAC- and saline-treated arthritic knees.1
What is Bone marrow concentrate injections?
Bone Marrow is the liquid spongy-type tissue found in the hallow (interior) of bones. It is primarily a fatty tissue that houses stem cells which are responsible for the formation of other cells. These mesenchymal stem cells (MSC), also called marrow stromal cells, can differentiate (change) into a variety of cell types including osteoblasts (bone cells), chondrocytes (cartilage cells), myocytes (muscle cells), adipocytes (fat), fibroblasts (ligament and tendon) and others when reintroduced into the body by injection. Bone marrow also contains hematopoietic stem cells that give rise to the white and red blood cells and platelets.
Why do you suggest Bone marrow concentrate injections?
Bone is a rich source of mesenchymal stem cells and has the potential to repair cartilage damage in osteoarthritis, and potentially slow down or improve the disease process.
Bone marrow is easily harvested from the posterior iliac crest (pelvic bone) and concentrated in an FDA compliant device.
The resultant Bone marrow concentrate has been shown to provide elevated levels of the healing factors listed above” hematopoietic stem cells, mesenchymal stem cells, blood platelets, chemokines (attracts white blood cells to areas of injury or infection) and cytokines (growth factor for healing).
Bone marrow concentrate also has anti-inflammatory, angiogenic (forms new blood vessels for improving circulation to injured area) and immunomodulatory properties (stimulates immune response) that can potentially enhance cartilage repair.2
Seven patient outcomes in the medical literature
In the medical journal Clinical Medicine Insights Arthritis and Musculoskeletal Disorders, Caring Medical published our findings in seven patients.
Patient case 1
A 59-year-old female patient come into our office with right ankle pain following a lateral sprain. The patient reported she could barely walk without severe ankle pain.
The patient had unsuccessful treatment with cortisone injections and was being recommended to ankle fusion based on X-ray and MRI finding that suggested osteoarthritis, avascular necrosis of the talus, and synovitis.
The patient received four bone marrow/dextrose treatments over a period of eight months.
- At second treatment, the patient reported the ability to stand for long periods and walk for half a mile without pain.
- At third treatment, she reported improved range of motion, less frequent pain, and ability to take two mile walks on hilly, uneven ground, although steep climbs still induced pain.
Patient case 2
A 69-year-old male came into our office with pain in both knees, with his right knee significantly more painful.Pain resulted in frequent sleep interruption and limitation of exercise.
The patient had received prolotherapy at another office in the previous two years but felt that the treatment has reached its maximum ability to heal.
The patient was diagnosed with osteoarthritis and received five bone marrow/dextrose treatments in each knee at two month intervals.
- Two months after the final treatment, the patient reported that he was completely free of pain or stiffness in both knees, had regained full range of motion, no longer suffered sleep interruption, and was no longer limited in exercise or daily life activities.
Patient case 3
A 76-year-old female came into our office with pain in both hips that had plagued her the last 3-4 years. Her left hip pain being more significant than the right. She was unable to walk more than a mile without significant pain. The patient had received a recommendation for hip replacement. X-rays revealed moderate to severe degenerative changes in both hips.
Degenerative disease of the lower lumbar spine were also noted.
The patient received seven bone marrow/dextrose treatments to each hip over a period of 12 months and adhered to a program of daily bicycle exercise.
- She reported incremental improvements in pain and function at each visit. At the final visit the patient reported significant gains since the onset of treatment with respect to range of motion, resumption of exercise, reduced crepitus, and reduction of pain medication use by two thirds. She reported her overall improvement as 90%.
Patient case 4
A 56-year-old female came into our office with pain in both knees and her right hip. She reported the knee pain started 3 years prior. Pain was severe in the right knee, with frequent crepitus and instability, and had forced the patient to discontinue running. MRI with a previous physician had shown cartilage degeneration. Right hip pain had been intermittent for 16 years, but instability and continuous pain began six months before her first office visit.
The hip pain prevented sleep on the affected side, bicycle exercise had stopped for more than a year, and walking exercise was limited to three miles.
MRI with a previous physician showed a hip labral tear.
The patient received bone marrow/dextrose treatments for six visits with 8–10 week intervals.
- The patient reported modest (20%–35%) overall improvement following these treatments. At the final two visits, both knees and right hip were treated with bone marrow prolotherapy injection. During the treatment period, the left hip was also treated for pain resulting from a flexor injury incurred following visit 1.
- Two months after visit 6, the patient reported 65%–95% overall improvement for the three joints. She is able to walk for two hours, no longer has disturbed sleep, and has been able to resume bicycle exercise with minimal discomfort.
Patient case 5
A 56-year-old male came into our office with pain in both knees. The patient is a former competitive weightlifter who continues to do strength training exercise. He complained of instability in both knees during exercise, as well as sleep interruption.
The patient received 29 bilateral dextrose prolotherapy treatments over five years.
At the final prolotherapy visit, sleep interruption was still present, pain intensity was 4/10, and pain frequency was 100%.
Four months later, the patient was treated with platelet-rich plasma. Three months after plasma treatment, the patient began a series of three bone marrow stem cell injection treatments (without dextrose prolotherapy) at 2–3 month intervals.
At the time of the second bone marrow stem cell injection treatments, stability was improved. At the time of the third treatment, pain intensity was 2/10 and pain frequency was 30%. Sleep was no longer affected. These gains were maintained for nine months.
Patient case 6
A 69-year-old female came into our office with pain in both knees. She had been previously diagnosed with osteoarthritis, had arthroscopic surgery to both knees eight years earlier, and medial meniscus repair in both knees 15 years earlier.
The patient reported pain occurred climbing or descending stairs and with standing or walking for two hours. Pain interrupted sleep and limited participation in racquet sports and golf.
The patient received six treatments in both knees with dextrose prolotherapy over a ten month period.
- After the first month of this period, the patient reported uninterrupted sleep, pain intensity of 2/10, resumption of limited golf, and an overall improvement of 50%–55%.
One year after the final prolotherapy, pain intensity had returned to 4/10 with a frequency of 20%, and sleep interruption had resumed. At this time, the patient received the first of two bone marrow stem cell injection/dextrose treatments, five months apart.
- At the time of the second treatment, pain intensity was 1/10 with a frequency of 20%, sleep interruption was reduced by half, and patient-reported overall improvement was 90%.
- Eight months following the final bone marrow stem cell injection/dextrose treatment, the patient reported being free of pain and able to resume full participation in all of her usual athletic activities.
Patient case 7
A 63-year-old male came into our office with pain in both hips.
The patient received five treatments with dextrose prolotherapy in both hips over a period of 5 months. During this period, the patient reported overall improvement of 50%; however, this reduced to 30%–40% at the conclusion of the treatment period, at which time pain intensity was 6/10 increased but with less frequency.
Crepitus, previously absent, was now marked. At this point, the patient began a series of two bone marrow stem cell injection/dextrose treatments two months apart.
At the time of the second treatment, pain intensity reduced. Crepitus was reduced. Specific pain manifestations previously noted, including ischial tuberosity pain and lateral hip pain, had abated, and the patient reported being able to walk without a cane for the first time in years.
Two months after the second bone marrow stem cell injection/dextrose treatments, pain intensity was 1/10 with a frequency of 10%. The patient reported walking without a limp and no longer needing a cane.
The Bone Marrow Stem Cell/Dextrose Treatment
Prolotherapy injections to enhance treatment
Additional injections are typically performed at the injury sites into and around the areas to enhance the healing effect. Most patients also receive Hackett-Hemwall Prolotherapy to help stabilize the joint and stimulate the repair of other structures that are contributing to the joint instability and/or pain for the patient.
1 Shapiro SA, Kazmerchak SE, Heckman MG, Zubair AC, O’Connor MI. A Prospective, Single-Blind, Placebo-Controlled Trial of Bone Marrow Aspirate Concentrate for Knee Osteoarthritis. Am J Sports Med. 2017 Jan;45(1):82-90. doi: 10.1177/0363546516662455. Epub 2016 Sep 30.
2 Oliver KS, Bayes MD Crane D, Pathikonda C. Clinical Outcome of Bone Marrow Concentrate in Knee Osteoarthritis. Journal of Prolotherapy. 2015;7:e937-e946.