Sean Mulvaney, M.D.

About BMAC

Bone marrow aspirate concentrate (BMAC) is used in musculoskeletal medicine to focus your own body’s ability to heal. It has many well-done published randomized control trials (RCT) and studies which demonstrate both its effectiveness and safety in many musculoskeletal conditions, including osteoarthritis, tendinopathies, and damaged vertebral discs. BMAC has been in clinical use since the 1990’s and has the most potential for musculoskeletal repair. The bone marrow is a rich source of mesenchymal stem cells (MSCs), which are a potent cell for focusing the body’s own repair process. MSCs bind to an injury site and initiate and organize repair to the damaged tissue. Precisely placing BMAC into the site of injury will initiate the healing process by activating on the damaged cartilage or tendon. This is an inflammatory process, and inflammation is the vital first phase of healing.

What to expect and how to prepare for BMAC

  • 2 weeks prior to the procedure: depending on the procedure, you may need to arrange

    for a driver to bring you home. IF you are having a lower extremity procedure, and IF you will not be able to manage using crutches, arrange for a wheelchair rental for 3 days (the day of and 2 days after your procedure). (Wheel chair rental available at Annapolis Healthcare Supplies, (40 dollars for 2-3 days), 410 295-7300). We can provide crutches as needed.

  • 7 days prior to the procedure: Stop taking anti-inflammatory drugs like ibuprofen, Naprosyn, Celebrex. Let your doctor know if you have been taking prednisone or other corticosteroids in the last month.

  • The day before the procedure: thoroughly shower and clean your skin. You will not be able to shower for 24 hours after the procedure.

  • The day of the procedure: Wear loose-fitting clothing like sweatpants or shorts. If you are having an upper body procedure wear a top that can button or zip up.

    BMAC will initiate healing and a productive inflammation, and BMAC therapy will make the body part treated sore for 4 days to two weeks. Anti-inflammatory drugs (i.e. ibuprofen, Naprosyn, Celebrex) and corticosteroids such as prednisone can blunt or stop this process, so it is important to not take any anti-inflammatory drugs for 7 days before getting BMAC therapy, or for at least three weeks after BMAC therapy. Corticosteroid injections can blunt inflammation for 30 days, so let us know if you have had one recently. Depending on the body part injected, you may be in a sling or on crutches for several days. Just like wringing out a wet dishcloth, if you load or tense a tendon or ligament that has just been injected with BMAC, some of the BMAC injected will squish out. By keeping the body part treated relaxed by using a sling (for the shoulder or arm) or crutches (for hips and legs) for a few days, the BMAC can bind in place and do its job. You will need a driver to bring you home. Tobacco is a potent toxin and its use constricts small blood vessels which are needed for tissue repair. Tobacco use will limit the effectiveness of any treatment and stopping tobacco use is one of the single greatest actions you can take to improve your health. Avoid toxins like alcohol, which inhibits and depresses the cells needed for tissue repair.

What happens during the BMAC procedure?

First, your bone marrow is aspirated or drawn out of the back part of the pelvis. This is really not as bad as it might sound. You will lay face down on a comfortable body pillow, and the skin over your lower back and hips will be thoroughly cleaned with a surgical skin preparation called Chloroprep and draped. Then, to make the procedure more comfortable and to numb the bone marrow cavity, we will do a procedure called a caudal epidural where we will inject 10 milliliters of a numbing medicine (lidocaine) into the epidural space just above the crack in your buttocks. Then using ultrasound guidance and sterile ultrasound gel, we will use a skin marking pen to map the procedure. We then numb the skin and the surface of the bone at the aspiration site. After the skin is numb, we use a special needle designed to go through bone to enter the bone marrow cavity in the hip bones near your lower back, near your buttocks. We use a small drill to do this. Then we aspirate the bone marrow into a syringe with a small amount of anti-coagulant (heparin) in it to keep the bone marrow from clotting during this process. Let me know if you have an allergy to heparin. This process is repeated at least at three sites on the bone, but up to six sites depending on the amount of BMAC needed to do the case. A bandage will be placed on the aspiration site. Then the bone marrow is filtered to get rid of very tiny bone fragments and is transferred in sterile fashion into a special centrifuge tube. It is then centrifuged for two cycles to isolate the MSCs to make the final BMAC. The skin at the injection site is numbed with a small needle and local anesthetic (buffered lidocaine). Dr Mulvaney will then precisely inject the BMAC into the injury site using ultrasound or fluoroscopic guidance.

What to do after your procedure

I will give you specific medicine to control any discomfort you may have after the procedure. Avoid NSAIDs like ibuprofen. Acetaminophen can be used for mild pain. Let me know if you have a history of opioid addiction so we can use appropriate pain medication. Avoid showering for 1 day and avoid immersion in water for 3 days. Any bandages can be removed after 1 day. Depending on the part of the body treated, usually you will be placed in a sling or on crutches for 1 to 3 days. Do your best not to tense or load the treated area during this time. After 3 days, unless otherwise instructed, the treated body part should be used and slowly moved through its full range of motion. It will be sore, but you will not be doing damage by moving it, in fact it needs to move to heal. If you were on crutches for a period of time, walking is ok once you are off the crutches. For now, avoid activities that specifically hurt you before being treated. Exercise is vital to good health and finding a way to cross train around your injury is important not only for your physical health, but for your mental health as well. Ask me about cross training options for your injury. Some brief (10 minutes or less) period of heat or ice therapy will not hurt the therapy, but it is not required. Usually, depending on the initial injury, physical therapy is started from two weeks to four weeks after injection. Improvements in pain and function should be expected from 12 weeks to 16 weeks after injection but may happen sooner.