OTA International (Mar 2019)

Bone marrow aspirate concentrate with cancellous allograft versus iliac crest bone graft in the treatment of long bone nonunions

  • Kenneth Lin, MD,
  • James VandenBerg, BS,
  • Sara M. Putnam, MD,
  • Christopher D. Parks, MD,
  • Amanda Spraggs-Hughes, MA,
  • Christopher M. McAndrew, MD, MSc,
  • William M. Ricci, MD,
  • Michael J. Gardner, MD

DOI
https://doi.org/10.1097/OI9.0000000000000012
Journal volume & issue
Vol. 2, no. 1
p. e012

Abstract

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Abstract. Objectives:. The purpose of this study was to compare bone marrow aspirate concentrate (BMAC) with cancellous allograft to iliac crest bone graft (ICBG) in the treatment of long bone nonunions. Design:. Retrospective cohort study. Setting:. A single level I trauma center. Patients:. 26 patients with long bone diaphyseal or metaphyseal nonunions with defects >2 mm and treated with open repair and BMAC, compared to 25 patients with long bone diaphyseal or metaphyseal nonunions with defects >2 mm and treated with open repair and ICBG. Intervention:. Open repair of long bone nonunion using either autologous ICBG or BMAC with cancellous allograft. Main outcome measure:. Nonunion healing, radiographically measured by the modified Radiographic Union Score for Tibia (mRUST) score. Secondary outcomes included risk factors associated with failed repair. Results:. The union rates for the BMAC and ICBG cohorts were 75% and 78%, respectively (P = .8). Infection was the only risk factor of statistical significance for failure. Conclusion:. In this study, we found no significant difference in union rate for long bone nonunions treated with ICBG or BMAC with allograft. BMAC and allograft led to 75% successful healing in this series. Given the heterogeneity of the control group and loss to follow-up, further prospective investigation should be conducted to more rigorously compare BMAC to ICBG for nonunion treatment. Level of evidence:. III, retrospective cohort.