Hernigou bone marrow grafting

Percutaneous autologous bone-marrow grafting for nonunions. Influence of the number and concentration of progenitor cells

Hernigou P, Poignard A, Beaujean F, et al. The Journal of bone and joint surgery. American volume 2005 · PMID 15995108 · doi:10.2106/jbjs.d.02215

Cohort studyManagementBasic scienceCitation checked

Question: Does percutaneous injection of concentrated iliac crest bone marrow heal atrophic tibial nonunions, and does success depend on progenitor cell dose?
Design: Prospective case series with quantification of progenitor cells (CFU-F) in the injected aspirate.
Patients: Adults with atrophic nonunion of the tibia.
Intervention: Percutaneous injection of concentrated autologous bone marrow aspirate
Comparison: Within-cohort comparison of healed versus unhealed nonunions by cell number and concentration
Primary outcome: Radiological and clinical union
Key result: Most nonunions united, and those that failed to heal had received significantly fewer and less concentrated progenitor cells, suggesting a dose threshold.
Limitations: Uncontrolled single-surgeon series; cell counting methods and concentration techniques vary between centres.
Impact on practice: The key clinical evidence that mesenchymal stem/progenitor cell number matters in bone healing; underpins use of concentrated bone marrow aspirate as an osteogenic adjunct.