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Bone Marrow Aspirate Concentrate (BMAC) Procedure

Mass General Brigham Sports Medicine offers BMAC—a procedure that may help reduce pain and restore function in joint and tendons. 

What is bone marrow aspirate concentrate?

Bone marrow aspiration is a procedure that involves taking a sample of the liquid part of the soft tissue inside your bones that contains a mixture of white blood cells (including progenitor cells, lymphocytes, and granulocytes) and platelets, as well as growth factors and proteins. Bone marrow aspirate concentrate (BMAC) treatment uses a patient’s own bone marrow aspirate for its potential to reduce inflammation and help restore normal function in joints and tendons in some patients.  

Who is a candidate for BMAC?

Patients who have moderate knee, hip, shoulder, or ankle osteoarthritis may benefit from BMAC if their pain interferes with their active lifestyle and they’ve already tried standard treatment, like physical therapy or injections. These patients aren’t candidates for surgery or they’re not yet ready for surgery. Not all patients are candidates for BMAC and most insurance companies currently don’t cover the procedure because it is still considered experimental.

Patients who aren’t candidates for BMAC include:

  • A patient with an active infection.
  • A patient with a history of cancer within the past 5 years.
  • A patient who hasn’t had standard treatments such as physical therapy.

Patients need to meet with a doctor as there may be other factors to consider when exploring BMAC treatment. We can help you find the best treatment option based on your health and goals. 

Where is the BMAC procedure performed? 

Patients have BMAC in an outpatient setting and you should be able to go home after the procedure. We recommend you arrange to have a family member or friend drive you home. If you traveled to the area by plane, you could fly home that evening.    

What happens during a BMAC procedure?

During a BMAC procedure, your doctor uses ultrasound as a guide to remove bone marrow aspirate (liquid) from a large bone (e.g., the pelvic bone). The liquid is used to make a concentrate that they inject into your damaged tissue that is intended to promote healing. The procedure takes about 2 hours. For the best results, you start rehab 2 weeks after the injection. During the first 2 weeks, you transition from using crutches to increasing your physical therapy and exercise program.  

Is the procedure safe?

Generally yes, research conducted over a 9-year span shows similar adverse effects to other joint injection options. 

Risks associated with BMAC are rare. Possible risks may include bleeding, infection, nerve damage, and pain that persists after the procedure is complete.

Is the procedure painful? 

Typically, patients generally tolerate the procedure well. Most of the reported complications for BMAC were nonspecific and self-limited, with the symptoms including pain, swelling, skin rash or itching, and aspirate site problems. Few severe complications have been reported and all the events generally resolved without any intervention. We recommend taking oral and topical pain medications to help decrease the pain prior to the procedure.  

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