SLR - October 2013 - Carl Brandon Lindberg
Reference: Christopher F. Hyer, DPM, MS, Gregory C. Berlet, MD, Bradly W. Bussewitz, DPM, Thomas Hankins, CCP, Heidi L. Ziegler, RN, and Terrence M. Philbin, DO. Quantitative Assessment of the Yield of Osteoblastic Connective Tissue Progenitors in Bone Marrow Aspirate from the Iliac Crest, Tibia, and Calcaneus. Journal of Bone Joint Surgery, 2013 July 17; 95 (14): 1312-1316.
Scientific Literature Review
Reviewed By: Carl Brandon Lindberg, DPM
Residency Program: University Hospital Newark, NJ
Podiatric Relevance: Bone marrow aspirate contains osteogenic cells, which can differentiate into bone, cartilage, muscle and fibrous tissue. It can be used to treat nonunions by stimulating new bone growth. Bone marrow aspirate can be harvested from multiple sites in the lower extremity including the tibia, calcaneus and femur. This study sought to quantify the amount of osteoprogenitor cells from each of these three different locations.
Methods: Three different harvest sights were examined for quantity of osteoprogenitor cells. They were the distal tibia, iliac crest and the calcaneus. Forty patients were included in the study and 10 mL of bone marrow aspirate was harvested from each of the sites. They were then diluted into three different concentrations and incubated at 37 degrees Celsius for nine days. On day nine the cells were fixed with cold ethanol and examined with a hemocytometer.
Results: Forty patients (22 female and 18 males) with an average age of fifty-one years participated in the study. Post-op pain was measured from each of the individuals and was found to be highest in the calcaneus. The prevalence of osteoprogenitor cells was found to be highest in the iliac crest followed by the tibia and calcaneus. The prevalence of viable cells was highest in the iliac crest followed by the tibia and calcaneus. Finally, the prevalence of osteogenic cells was highest in the iliac crest followed by the tibia and calcaneus. No difference was found between any other variables examined which included age, sex, diabetes and tobacco use.
Conclusions: Bone marrow aspirate is available from multiple locations in the lower extremity. The results from this study show the greatest percentage of osteoprogenic cells are available from the iliac crest.