Autologous Bone Marrow Clot As an Alternative to Autograft for Bone Defect Healing

Overview

Journal Bone Joint Res

Date 2019 Apr 19

PMID 30997036

Citations 13

Authors

Z X H Lim

B Rai

T C Tan

A K Ramruttun

J H Hui

V Nurcombe

S H Teoh

S M Cool

Affiliations

Soon will be listed here.

Abstract

Objectives: Long bone defects often require surgical intervention for functional restoration. The 'gold standard' treatment is autologous bone graft (ABG), usually from the patient's iliac crest. However, autograft is plagued by complications including limited supply, donor site morbidity, and the need for an additional surgery. Thus, alternative therapies are being actively investigated. Autologous bone marrow (BM) is considered as a candidate due to the presence of both endogenous reparative cells and growth factors. We aimed to compare the therapeutic potentials of autologous bone marrow aspirate (BMA) and ABG, which has not previously been done.

Methods: We compared the efficacy of coagulated autologous BMA and ABG for the repair of ulnar defects in New Zealand White rabbits. Segmental defects (14 mm) were filled with autologous clotted BM or morcellized autograft, and healing was assessed four and 12 weeks postoperatively. Harvested ulnas were subjected to radiological, micro-CT, histological, and mechanical analyses.

Results: Comparable results were obtained with autologous BMA clot and ABG, except for the quantification of new bone by micro-CT. Significantly more bone was found in the ABG-treated ulnar defects than in those treated with autologous BMA clot. This is possibly due to the remnants of necrotic autograft fragments that persisted within the healing defects at week 12 post-surgery.

Conclusion: As similar treatment outcomes were achieved by the two strategies, the preferred treatment would be one that is associated with a lower risk of complications. Hence, these results demonstrate that coagulated BMA can be considered as an alternative autogenous therapy for long bone healing.: Z. X. H. Lim, B. Rai, T. C. Tan, A. K. Ramruttun, J. H. Hui, V. Nurcombe, S. H. Teoh, S. M. Cool. Autologous bone marrow clot as an alternative to autograft for bone defect healing. 2019;8:107-117. DOI: 10.1302/2046-3758.83.BJR-2018-0096.R1.

Citing Articles

Bone marrow fluid enhances the osteogenic activity of induced membrane leading to spontaneous osteogenesis: experimental validation and application in tibiofibular fusion for support reconstruction of segmental tibial defects.

Yin Q, Chen X, Du S, Wei X, Wu Y, Bu F J Transl Med. 2025; 23(1):239.

PMID: 40016829 PMC: 11869740. DOI: 10.1186/s12967-024-05840-1.

Innovative Approaches in Knee Osteoarthritis Treatment: A Comprehensive Review of Bone Marrow-Derived Products.

Lana J, Purita J, Jeyaraman M, de Souza B, Rodrigues B, Huber S Biomedicines. 2025; 12(12.

PMID: 39767717 PMC: 11672900. DOI: 10.3390/biomedicines12122812.

An in vivo study to investigate an original intramedullary bone graft harvesting technology.

Laubach M, Bessot A, McGovern J, Saifzadeh S, Gospos J, Segina D Eur J Med Res. 2023; 28(1):349.

PMID: 37715198 PMC: 10503043. DOI: 10.1186/s40001-023-01328-8.

Platelet-Rich Plasma Power-Mix Gel (ppm)-An Orthobiologic Optimization Protocol Rich in Growth Factors and Fibrin.

Lana J, Purita J, Everts P, De Mendonca Neto P, Jorge D, Mosaner T Gels. 2023; 9(7).

PMID: 37504432 PMC: 10379106. DOI: 10.3390/gels9070553.

The reconstruction of critical bone loss : the holy grail of orthopaedics.

Tsang S, Ferreira N, Simpson A Bone Joint Res. 2022; 11(6):409-412.

PMID: 35731230 PMC: 9233404. DOI: 10.1302/2046-3758.116.BJR-2022-0186.

References

Curylo L, Johnstone B, Petersilge C, Janicki J, Yoo J . Augmentation of spinal arthrodesis with autologous bone marrow in a rabbit posterolateral spine fusion model. Spine (Phila Pa 1976). 1999; 24(5):434-8; discussion 438-9. DOI: 10.1097/00007632-199903010-00004. View

Russell J, Block J . Surgical harvesting of bone graft from the ilium: point of view. Med Hypotheses. 2000; 55(6):474-9. DOI: 10.1054/mehy.2000.1095. View

Salgado R, Benoy I, Bogers J, Weytjens R, Vermeulen P, Dirix L . Platelets and vascular endothelial growth factor (VEGF): a morphological and functional study. Angiogenesis. 2002; 4(1):37-43. DOI: 10.1023/a:1016611230747. View

Heemskerk J, Bevers E, Lindhout T . Platelet activation and blood coagulation. Thromb Haemost. 2002; 88(2):186-93. View

Fiedler J, Roderer G, Gunther K, Brenner R . BMP-2, BMP-4, and PDGF-bb stimulate chemotactic migration of primary human mesenchymal progenitor cells. J Cell Biochem. 2002; 87(3):305-12. DOI: 10.1002/jcb.10309. View

Kokubo S, Fujimoto R, Yokota S, Fukushima S, Nozaki K, Takahashi K . Bone regeneration by recombinant human bone morphogenetic protein-2 and a novel biodegradable carrier in a rabbit ulnar defect model. Biomaterials. 2003; 24(9):1643-51. DOI: 10.1016/s0142-9612(02)00551-3. View

Bain B . Bone marrow biopsy morbidity and mortality. Br J Haematol. 2003; 121(6):949-51. DOI: 10.1046/j.1365-2141.2003.04329.x. View

Ralis Z, Watkins G . Modified tetrachrome method for osteoid and defectively mineralized bone in paraffin sections. Biotech Histochem. 1992; 67(6):339-45. DOI: 10.3109/10520299209110046. View

Sipe J, Zhang J, Waits C, Skikne B, Garimella R, Anderson H . Localization of bone morphogenetic proteins (BMPs)-2, -4, and -6 within megakaryocytes and platelets. Bone. 2004; 35(6):1316-22. DOI: 10.1016/j.bone.2004.08.020. View

10.

Khan S, Cammisa Jr F, Sandhu H, Diwan A, Girardi F, Lane J . The biology of bone grafting. J Am Acad Orthop Surg. 2005; 13(1):77-86. View

11.

Bain B . Bone marrow biopsy morbidity: review of 2003. J Clin Pathol. 2005; 58(4):406-8. PMC: 1770618. DOI: 10.1136/jcp.2004.022178. View

12.

Kraiwattanapong C, Boden S, Louis-Ugbo J, Attallah E, Barnes B, Hutton W . Comparison of Healos/bone marrow to INFUSE(rhBMP-2/ACS) with a collagen-ceramic sponge bulking agent as graft substitutes for lumbar spine fusion. Spine (Phila Pa 1976). 2005; 30(9):1001-7. DOI: 10.1097/01.brs.0000160997.91502.3b. View

13.

Kitchel S, Wang M, Lauryssen C . Techniques for aspirating bone marrow for use in spinal surgery. Neurosurgery. 2005; 57(4 Suppl):286-9. DOI: 10.1227/01.neu.0000176412.17360.95. View

14.

Becker S, Maissen O, Ponomarev I, Igor P, Stoll T, Thierry S . Osteopromotion by a beta-tricalcium phosphate/bone marrow hybrid implant for use in spine surgery. Spine (Phila Pa 1976). 2006; 31(1):11-7. DOI: 10.1097/01.brs.0000192762.40274.57. View

15.

Neen D, Noyes D, Shaw M, Gwilym S, Fairlie N, Birch N . Healos and bone marrow aspirate used for lumbar spine fusion: a case controlled study comparing healos with autograft. Spine (Phila Pa 1976). 2006; 31(18):E636-40. DOI: 10.1097/01.brs.0000232028.97590.12. View

16.

Dominici M, Le Blanc K, Mueller I, Slaper-Cortenbach I, Marini F, Krause D . Minimal criteria for defining multipotent mesenchymal stromal cells. The International Society for Cellular Therapy position statement. Cytotherapy. 2006; 8(4):315-7. DOI: 10.1080/14653240600855905. View

17.

Italiano Jr J, Richardson J, Patel-Hett S, Battinelli E, Zaslavsky A, Short S . Angiogenesis is regulated by a novel mechanism: pro- and antiangiogenic proteins are organized into separate platelet alpha granules and differentially released. Blood. 2007; 111(3):1227-33. PMC: 2214735. DOI: 10.1182/blood-2007-09-113837. View

18.

Kalen A, Wahlstrom O, Halling Linder C, Magnusson P . The content of bone morphogenetic proteins in platelets varies greatly between different platelet donors. Biochem Biophys Res Commun. 2008; 375(2):261-4. DOI: 10.1016/j.bbrc.2008.08.014. View

19.

Clarke B . Normal bone anatomy and physiology. Clin J Am Soc Nephrol. 2008; 3 Suppl 3:S131-9. PMC: 3152283. DOI: 10.2215/CJN.04151206. View

20.

Soltan M, Smiler D, Choi J . Bone marrow: orchestrated cells, cytokines, and growth factors for bone regeneration. Implant Dent. 2009; 18(2):132-41. DOI: 10.1097/ID.0b013e3181990e75. View