Bone marrow aspirate concentrate (BMAC) is a biologic therapy for treating musculoskeletal injuries and diseases. A healthcare provider extracts it from your bone marrow and injects it into your injured tissues to help them repair and regenerate.

BMAC is a concentrated solution of cells and proteins extracted from bone marrow. It contains stem cells, anti-inflammatory cytokines and growth factors — proteins that trigger cellular growth and repair.

Your bone marrow is the soft, spongy tissue at the center of your bones that produces your blood cells. This process relies on stem cells and growth factors, making bone marrow an excellent source of them.

Healthcare providers harvest them in a procedure called bone marrow aspiration: They draw a sample of the liquid part of your bone marrow through a hollow needle. The sample is called bone marrow aspirate.

They produce bone marrow aspirate concentrate (BMAC) by processing and distilling this sample. The concentrated form is about six times denser with cells and growth factors than the original aspirate.

Healthcare providers have been experimenting with using BMAC to help repair and regenerate damaged tissues in your musculoskeletal system — tissues like muscles, bones, cartilage, tendons and ligaments.

If you’ve had a traumatic injury or have a degenerative tissue disease like osteoarthritis, BMAC can help promote healing. It contains the raw cellular materials your body needs to regenerate these tissues.

A healthcare provider can treat your injured tissues with contents extracted from your own bone marrow. After aspirating and concentrating the liquid, they can deliver it to the tissues that need it.

Surgery is one way of doing this. But a simpler way is to inject the liquid into the injured tissues through a hollow needle. A BMAC injection is an outpatient procedure that you can get in your provider’s office.

BMAC contains concentrated doses of stem cells and growth factors, which stimulates tissue growth and repair. Stem cells are cells in their raw form before they specialize to become different types of tissues.

Mesenchymal stem cells (MSCs) are the type of stem cells that replenish soft tissues, cartilage and bone. They’re less abundant in bone marrow than other types, so a concentrated dose is more likely to help.

BMAC also promotes healing by reducing inflammation and scarring (fibrosis). Severe or long-lasting inflammation can lead to scarring. While scarring is a type of healing, it’s not the same as regenerating.

Scar tissue is dense, fibrous tissue that may not have the same blood supply, flexibility or functionality as the original tissue. But when tissues regenerate, they replace damaged cells with the same type of cell.

Healthcare providers have used BMAC injections to promote the healing of:

  • Sports injuries, like bone fractures, tendonitis or partial tendon tears.
  • Chronic and nonhealing wounds, like diabetes-related foot wounds.
  • Musculoskeletal disorders, like degenerative arthritis and degenerative disk disease.
  • Dental bone grafts and implants during oral surgery.

The BMAC procedure has three parts:

  1. Bone marrow aspiration.
  2. Bone marrow aspirate concentrating.
  3. Bone marrow aspirate concentrate (BMAC) injection.

Bone marrow aspiration

Bone marrow aspiration is the procedure where your healthcare provider will harvest your bone marrow using a hollow needle. They’ll usually draw it from a large bone, like your pelvic bone.

They’ll insert the needle through your lower back, close to your hip. First, they’ll inject numbing medication. Once you’re numb, they’ll attach a syringe to the needle and extract the bone marrow.

Bone marrow aspirate processing

Different providers use different methods for processing and concentrating the aspirate. It takes about 30 minutes while you wait. When the BMAC is ready to use, your provider will collect it into a syringe.

Bone marrow aspirate concentrate (BMAC) injection

The BMAC injection procedure is just like the extraction. Your provider will locate the injection site using radiology imaging (like ultrasound or fluoroscopy). They’ll numb the site first, and then inject the BMAC.

The whole procedure takes about two hours. After that, you can go home. If the injection site is sore, apply ice and use over-the-counter (OTC) pain relievers as needed. Most people say this only lasts a few days.

Bone marrow aspirate concentrate (BMAC) injections encourage tissue regeneration and healing from musculoskeletal injuries and disorders. They aren’t a cure, but they can be a helpful complementary therapy.

They can:

  • Reduce symptoms like inflammation, pain and stiffness.
  • Kick-start healing of nonhealing or chronic wounds.
  • Help you recover faster from injuries.
  • Potentially enhance your response to reconstructive surgery or grafting.

There’s little risk of complications from BMAC injections. The most common side effect is temporary pain and swelling, lasting a few days. Other possible negative outcomes include:

  • A temporary inflammatory reaction, like a fever or rash.
  • Excessive bleeding or infection at the injection site.
  • Injury to nearby blood vessels or nerves.
  • No improvement from the treatment.

BMAC injections have shown encouraging results in treating all kinds of musculoskeletal conditions. But they’re still a new treatment, and there’s not enough evidence yet to say they’ll work for everyone.

Different factors may affect how well BMAC works for you, including the condition you’re treating, how advanced it is and your overall health. Your provider can tell you more about what you can expect.

  • Chahla J, Mannava S, Cinque ME, Geeslin AG, et al. Bone Marrow Aspirate Concentrate Harvesting and Processing Technique (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5443590/)Arthrosc Tech. 2017 Apr 10;6(2):e441-e445. Accessed 6/16/2024.
  • Holton J, Imam M, Ward J, Snow M. The Basic Science of Bone Marrow Aspirate Concentrate in Chondral Injuries (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5066111/)Orthop Rev (Pavia). 2016 Sep 30;8(3):6659. Accessed 6/16/2024.
  • Kim GB, Seo MS, Park WT, Lee GW. Bone Marrow Aspirate Concentrate: Its Uses in Osteoarthritis (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7247342/)Int J Mol Sci. 2020 May 2;21(9):3224. Accessed 6/16/2024.
  • Lana JFSD, da Fonseca LF, Macedo RDR, Mosaner T, et al. Platelet-rich plasma vs bone marrow aspirate concentrate: An overview of mechanisms of action and orthobiologic synergistic effects (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7933989/)World J Stem Cells. 2021 Feb 26;13(2):155-167. Accessed 6/16/2024.
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