Bone Marrow Aspirate Concentrate
Cellular concentrate derived from iliac crest marrow — applied in cartilage, ligament, and tendon procedures where higher concentrations of regenerative signaling cells are clinically indicated.
What It Is / How It Works
Bone Marrow Aspirate Concentrate (BMAC) is harvested from the posterior iliac crest — a minimally invasive procedure performed under local anesthesia. The aspirate is then centrifuged to concentrate mesenchymal stem cells (MSCs), hematopoietic progenitor cells, platelets, and a broad array of growth factors. This multi-cellular concentrate carries a more complex regenerative signal than PRP alone, making it particularly suited for cartilage and higher-demand tissue applications.
MSCs within BMAC have the capacity to differentiate into cartilage, bone, and connective tissue lineages. They also exert paracrine effects — modulating the local inflammatory environment and promoting endogenous healing through cell signaling rather than direct cell replacement.
Who Is a Candidate
BMAC is typically considered for patients with focal cartilage defects, early-stage osteonecrosis of the femoral head, moderate knee or hip osteoarthritis that has not responded to more conservative injectable options, and as an adjunct in select surgical repairs. Patients with realistic expectations who are not yet candidates for, or wish to delay, joint replacement or major reconstructive surgery are often reasonable candidates.
Contraindications include active local or systemic infection, known bone marrow disorders or hematologic malignancy, significant coagulopathy or anticoagulation that cannot be safely held, and advanced bone-on-bone arthritis where biologic augmentation is unlikely to meaningfully change the clinical course. As with other autologous biologic therapies, patients are counseled that BMAC is not a substitute for surgery when structural indications for surgery are already present.
What to Expect
BMAC harvest is typically performed in an office or ambulatory procedure setting under local anesthesia. Bone marrow is aspirated from the posterior iliac crest using a specialized needle, then processed in a centrifuge to concentrate mesenchymal stem cells, hematopoietic progenitor cells, and platelets while removing red blood cells and excess plasma. The concentrate is then delivered to the target joint or tissue under ultrasound or fluoroscopic guidance, depending on the anatomic site.
The harvest and injection together usually take around 45 minutes to an hour. Aspiration site soreness at the iliac crest is common for several days and is managed with standard analgesics and activity modification. Weight-bearing and activity restrictions afterward depend on the treated joint and are individualized by the treating physician, with a structured rehabilitation plan typically following.
Evidence Base
- Bone Marrow Aspirate Concentrate Injections for the Treatment of Knee Osteoarthritis: A Systematic Review of Randomized Controlled Trials. PMID: 39640186 ↗
- Management of knee osteoarthritis using bone marrow aspirate concentrate: a systematic review. PMID: 39506910 ↗
- Clinical Efficacy of Bone Marrow Aspirate Concentrate Versus Stromal Vascular Fraction Injection in Patients With Knee Osteoarthritis: A Systematic Review and Meta-analysis. PMID: 34102078 ↗
- The efficacy of core decompression combined with regenerative therapy in early femoral head necrosis: a systematic review and meta-analysis involving 954 subjects. PMID: 39840080 ↗
- Cell-based versus corticosteroid injections for knee pain in osteoarthritis: a randomized phase 3 trial. PMID: 37919438 ↗
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