Table 2.

Advantages and Disadvantages of BMAC Harvest from the Proximal Tibia, Proximal Humerus, and Anterior Superior Iliac Spine

Advantages

•BMAC harvest from the proximal tibia, proximal humerus, and ASIS is easily incorporated into the surgical workflow for concomitant knee, shoulder, and hip procedures, respectively.

•Minimal operative time is added to the procedure.

•Patient positioning and draping are unchanged from standard surgical setups for the specific surgical site.

•The anatomy is familiar to and comfortable for the sports medicine surgeon, with safe zones to access BMAC with minimal risk to surrounding neurovascular and other key anatomical structures.

•The procedure is technically simple.

•The donor site is located adjacent to where the primary procedure is occurring, thereby limiting the number of locations at which a patient may have postoperative pain.

•Because the concentrate is autologous, there is minimal risk of allogeneic disease transmission and infection.

•The harvest incision is small and versatile with reliable wound healing and can be incorporated into or placed separately from other incisions.

Disadvantages

•Yield from the proximal tibia and proximal humerus may not be as high quality as the gold standard iliac crest, particularly in older patients.

•Preoperative planning ahead of the surgical date is required to ensure the proper equipment is available.

•Patient informed consent should include an open discussion of associated costs with BMAC harvest and application, particularly since in many current health systems the procedure is not covered by insurance, thereby resulting in out-of-pocket costs to the patient.

•There may be additional donor-site pain at the harvest location.

•Ongoing research is needed to clarify the impact of BMAC harvest, particularly from different sites, on outcomes in a variety of surgical procedures.

ASIS, anterior superior iliac spine; BMAC, bone marrow aspirate concentrate.