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Laboratory Quantification of Bone Marrow Concentrate Components in Unilateral Versus Bilateral Posterior Superior Iliac Spine Aspiration

Peter A. Everts

ABSTRACT
Mesenchymal Stem Cells (MSCs) from Bone Marrow Concentrate (BMC) have emerged as a promising treatment
for degenerative musculoskeletal pathologies, such as Osteoarthritis (OA). Many aspiration techniques have been
described in the literature with little consensus on optimal methodology. This study aimed to compare MSC
quantity in unilateral versus bilateral Posterior Superior Iliac Spine (PSIS) bone marrow aspirate concentrations.
Patients with unilateral knee OA seeking treatment with intraarticular BMC were recruited and randomized to a
unilateral PSIS Bone Marrow Aspiration (BMA) or a bilateral PSIS BMA of equal total volumes. BMA and BMC
samples underwent laboratory analysis of Colony Forming Unit-Fibroblasts (CFU-fs) as a marker for MSCs, for
quantification of Total Nucleated Cell (TNC) count, and CD-34 positivity, in addition to other metrics. Data from
26 patients were analyzed. Mean total CFU-fs were 1.9 times higher in the bilateral group (n=13) versus the unilateral
group (n=13); 42,912 versus 23,038, respectively (p=0.17). The median number of CFU-fs cultured from 1 ml of
BMC in the bilateral cohort was 33% higher than the unilateral group (2477 versus 1860 CFU-fs/ml, respectively
(p=0.23). Despite the difference in CFU-fs, the TNC counts were similar between the two groups. This descriptive
study suggests a lower volume; multisite draw-technique for BMA increases the absolute number of CFU-fs, and
therefore the correlated MSC count. Due to the limited statistical power, these data will need to be further evaluated
with a larger patient dataset and correlated with patient outcomes data to determine clinical significance.