Feasibility of In-Office BMA or Lipo-Aspirate

The field of ortho-biologics has been expanding rapidly over the last 10 years! Platelet Rich Plasma (PRP) has been dominating research which in turn has led many physicians who treat musculoskeletal conditions to adapt their practice to now offer PRP treatment for many orthopedic conditions. Take knee osteoarthritis (OA), there now exists more than 30 RCT for knee OA showing positive benefits when compared to traditional standard of care treatment such as visco-supplementation, corticosteroids, and physical therapy.



Adding PRP to a clinical practice is relatively easy transition which requires a phlebotomist or trained personnel to complete a blood draw and then process of the blood (bedside centrifuge or flexible lab platform) which in turn delivers the final injectate at the time of the procedure. PRP has been a game changer for so many orthopedic conditions such as lateral epicondylitis (1), mild to moderate knee and hip OA (2,3), and various spine conditions (4). But more advanced pathology such as large rotator cuff tears (5), moderate to severe knee OA (6), and ACL tears (7) autologous bone marrow concentrate (BMC) has been demonstrated to have higher efficacy. Despite BMC superiority compared to PRP for many orthopedic conditions, many interventional physicians have elected not to offer these treatments because they assume that without the friendly confines for a hospital OR with anesthesia, they will not be able safely perform these procedures in an out-patient based clinic.


THE UP-SIDE:


Collectively with over 20 years of clinical experience in the use of orthop-biologics, our physicians assure you that performing a high-quality bone marrow aspiration in an outpatient office procedure room is feasible and safe! If you would like the opportunity to maximize your patient’s outcomes with the use of BMC, we have many options for our physicians to give you the tools and confidence to perform this procedure safely, effectively and in timely manner. After detailed training either at your home or ours, we are confident that you will be able to start performing these procedures


In our current COVID-19 crisis, where patients are electing to stay clear of any hospital based treatments such as shoulder or knee replacement, it is critical to have a good treatment option for our patients that can be done safely and effectively in an out-patient office setting and we can help get you there!





1. Houck DA, Kraeutler MJ, Thornton LB, McCarty EC, Bravman JT. Treatment of Lateral Epicondylitis With Autologous Blood, Platelet-Rich Plasma, or Corticosteroid Injections: A Systematic Review of Overlapping Meta-analyses. Orthop J Sports Med. 2019;7(3):2325967119831052. Published 2019 Mar 14. doi:10.1177/2325967119831052 https://pubmed.ncbi.nlm.nih.gov/30899764/


2. Su K, Bai Y, Wang J, Zhang H, Liu H, Ma S. Comparison of hyaluronic acid and PRP intra-articular injection with combined intra-articular and intraosseous PRP injections to treat patients with knee osteoarthritis. Clin Rheumatol. 2018;37(5):1341-1350. doi:10.1007/s10067-018-3985-6 https://pubmed.ncbi.nlm.nih.gov/29388085/


3. Singh JR, Haffey P, Valimahomed A, Gellhorn AC. The Effectiveness of Autologous Platelet-Rich Plasma for Osteoarthritis of the Hip: A Retrospective Analysis. Pain Med. 2019;20(8):1611-1618. doi:10.1093/pm/pnz041 https://pubmed.ncbi.nlm.nih.gov/30958873/

4. Urits I, Viswanath O, Galasso AC, et al. Platelet-Rich Plasma for the Treatment of Low Back Pain: a Comprehensive Review. Curr Pain Headache Rep. 2019;23(7):52. Published 2019 Jul 3. doi:10.1007/s11916-019-0797-6 https://pubmed.ncbi.nlm.nih.gov/31270622/


5. Centeno C, Fausel Z, Stemper I, Azuike U, Dodson E. A Randomized Controlled Trial of the Treatment of Rotator Cuff Tears with Bone Marrow Concentrate and Platelet Products Compared to Exercise Therapy: A Midterm Analysis. Stem Cells Int. 2020;2020:5962354. Published 2020 Jan 30. doi:10.1155/2020/5962354 https://pubmed.ncbi.nlm.nih.gov/32399045/


6. Hernigou P, Auregan JC, Dubory A, Flouzat-Lachaniette CH, Chevallier N, Rouard H. Subchondral stem cell therapy versus contralateral total knee arthroplasty for osteoarthritis following secondary osteonecrosis of the knee. Int Orthop. 2018;42(11):2563-2571. doi:10.1007/s00264-018-3916-9 https://pubmed.ncbi.nlm.nih.gov/29589086/


7. Centeno C, Markle J, Dodson E, et al. Symptomatic anterior cruciate ligament tears treated with percutaneous injection of autologous bone marrow concentrate and platelet products: a non-controlled registry study. J Transl Med. 2018;16(1):246. Published 2018 Sep 3. doi:10.1186/s12967-018-1623-3 https://pubmed.ncbi.nlm.nih.gov/30176875/

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