BMAC (Bone marrow aspirated concentrate) injection: Myth and truth

Introduction

The term "stem cell treatment" is highly appealing, drawing attention from both the public and the media. However, does stem cell therapy guarantee magical results? The answer is: not always.

While stem cell procedures can yield positive outcomes in carefully selected cases, they may provide little to no benefit in inappropriate cases, making the high cost of treatment unjustifiable.

it is not uncommon to see patients who have undergone stem cell procedures at other hospitals without significant improvement—or, in some cases, with worsening symptoms. 

Hereby, I introduce a typical case frequently encountered in outpatient clinics.

Case: 48-Year-Old Female with Knee Osteoarthritis

This patient developed knee osteoarthritis at a relatively young age. 

She previously visited other hospital a year ago, where an X-ray revealed medial compartment degenerative osteoarthritis (Kellgren-Lawrence grade 2).

 

Bell-Thompson view X-ray (above) shows moderate varus malalignment (bow-legged deformity), contributing to the progression of medial compartment arthritis.

MRI was taken for further evaluation.

As shown above, high grade, diffuse cartilage lesion was observed (Blue arrow) in the medial compartment. 

In addition, medial meniscal tear with insufficient remaining meniscus tissue was found. (White arrow)

Considering these findings, it was highly predictable that cartilage regeneration procedures alone would not yield favorable outcomes.

What Was the Appropriate Treatment?

The most necessary treatment for this patient was high tibial osteotomy (HTO) to correct the varus deformity and to prevent further progression of osteoarthritis. Cartilage regeneration procedures could have been considered only as an adjunctive option.

 

However, the patient underwent bilateral BMAC (Bone marrow aspirated concentrate) stem cell therapy alone (without HTO). As a result, her knee pain worsened over the following year, eventually requiring high tibial osteotomy at our hospital.

Postoperative X-ray (distal tubercle high tibial osteotomy) 

  

This case clearly illustrates that stem cell procedures alone are not the solution for malalignment-associated osteoarthritis.

 

Discussion

"Microfracture + stem cell"  is a simple procedure, profittable, and requires short er surgical time.

Some physicians opt for the "easier route" of performing microfracture and stem cell procedures rather than addressing the real problem.

Patients, too, often gravitate toward the "less scary" option of stem cells, rather than undergoing necessary surgical interventions.

However, if a patient is not an appropriate candidate for microfracture, then stem cells or collagen will not be effective either.

Thus, before making decisions, it is essential to consider:

- Is the underlying cause (e.g., malalignment) being addressed?
- Is this procedure supported by strong clinical evidence?
- Are there better alternative treatments for long-term outcomes?

 

By carefully assessing these factors, patients and physicians can make more informed and effective treatment decisions.

Hyo Yeol Lee, MD., PhD.

Department of Orthopaedic Surgery (Knee Surgery and Sports Medicine)

Chungbuk National University Hospital