**7.3 Osteonecrosis**

Philippe Hernigou, world renowned for treating femoral head osteonecrosis, advocates the use of autologous BMC cell therapies [123]. He described a substantial repair and stabilization of necrotic femoral heads with percutaneous injection of autologous BMC, in combination with surgical core decompression. In a later paper, he reviews three decades of BMC therapies in hip osteonecrosis, emphasizing the quality of the BMC and cellular competence and addressing the effects of BM cell concentrates on the microenvironmental changes within osteonecrotic bone [124]. Other groups reported on prospective randomized clinical trials for femoral head osteonecrosis, comparing surgical decompression alone versus decompression augmented by autologous BMC preparations. The biologics were implanted during the surgical decompression procedure. In one study, patients were evaluated using the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index questionnaire, VAS pain index, and MRI. The mean WOMAC and VAS scores in all patients improved significantly (*P* < 0.001). Post-procedural MRIs showed a significant (*P* = 0.046) improvement in patients in whom the surgical procedure was combined with BMC [125]. In a similar study, a significant decrease in pain associated with a functional benefit lasting the entire observation period was observed in the BMC-treated patients. However, no difference in clinical outcomes between

**27**

*The Rationale of Autologously Prepared Bone Marrow Aspirate Concentrate for use…*

the two study groups was seen during a 2-year follow-up period, with no significant difference between the femoral head survival rate [126]. Importantly, they analyzed the MSC and nuclear cell content of the BMC. There was a significant rise in nuclear cells and CFU-Fs (6.3-fold and 1.5-fold baseline values, respectively). Despite a significant rise in CFU-Fs in the BMC, the total deliverable MSC cell counts were relatively low. This might be related to the design features and specifications of the fully automated, sensor-controlled processing BMC device that was used with a

Awad and associates recently published a meta-analysis on knee cartilage repair [127]. They conducted a systematic review using the PRISMA guidelines and the *Cochrane Handbook for Systematic Reviews of Interventions*. A meta-analysis was conducted to estimate the effect size for function and pain in 724 patients, with a mean age of 44.2 years. In this review, both cultured BM-MSCs and autologous noncultured BMC were used. All autologous BMC treatment specimens were prepared following a two-step centrifugation method. Their most important meta-analytic finding was that the administration of non-cultured, fresh, BMC significantly reduced pain and improved knee function. This might be induced by the heterogeneous composition of the non-cultured BMC, as all constituents will synergistically foster cartilage regeneration and local pain management. Furthermore, BMC holds a certain volume of autologous plasma which can function as a cellular scaffold with the advantage of a more sustained release, compared to a pure cultured MSC

In a retrospective study, Stein et al. used BMC for primary Achilles tendon repairs, following traumatic injuries [128]. The BMC was adjunct to augment the surgical correction. Although the study lacked a control group, at a mean followup of 30 months, there were no re-ruptures reported. In a small patient study, centrifuged BMC specimen were injected in patients, refractory to conservative therapies, with clinical and radiological evidence of chronic patellar tendinopathy. Long-term follow-up showed statistically significant improvement in the majority of its reported scores [129]. A series of patients, diagnosed with clinical lateral epicondylitis, were treated with a single-spin BMC protocol. A significant improvement was noted when pre-BMC scores were compared with postinjection scores, at 12-weekpost-intervention. The authors suggested that BMC injections in patients who have failed non-operative treatment, before a surgical intervention, should be considered, and in their belief BMC injections can be developed as second-line conservative treatment in chronic tendinopathy, potentially reversing the degenera-

Degenerative disk disease (DDD) affects the disks that separate the spine bones. Age-related changes can lead to arthritis, disk herniation, or spinal stenosis. Pressure on the spinal cord and nerves may cause pain. DDD is associated with significant morbidity. Conservative treatment options, physical therapy, self-care, medication, and spinal injections are used to manage the symptoms. However, these measures are often not significantly responsive. Surgery has been an option if the

*DOI: http://dx.doi.org/10.5772/intechopen.91310*

single-step centrifugation protocol.

**7.4 Cartilage repair**

product.

**7.5 Tendinopathies**

tive process [130].

**8. Bone marrow concentrates in spinal disorders**

#### *The Rationale of Autologously Prepared Bone Marrow Aspirate Concentrate for use… DOI: http://dx.doi.org/10.5772/intechopen.91310*

the two study groups was seen during a 2-year follow-up period, with no significant difference between the femoral head survival rate [126]. Importantly, they analyzed the MSC and nuclear cell content of the BMC. There was a significant rise in nuclear cells and CFU-Fs (6.3-fold and 1.5-fold baseline values, respectively). Despite a significant rise in CFU-Fs in the BMC, the total deliverable MSC cell counts were relatively low. This might be related to the design features and specifications of the fully automated, sensor-controlled processing BMC device that was used with a single-step centrifugation protocol.
