Comparison of Humeral Head Versus Iliac Crest Bone Marrow Aspirate Concentrate in Patients Undergoing Arthroscopic...

The purpose of this exploratory pilot study was to compare the composition of humeral head (HH) and iliac crest (IC) bone marrow aspirates (BMA) and establish a framework for evaluating bone marrow aspirate concentrate (BMAC) in arthroscopic rotator cuff repair (RCR). Fifteen patients (mean age of 60, range: 41-74) with full-thickness RC tears underwent arthroscopic RCR with BM aspiration (30 mL) from both the HH and IC. Mononuclear cells (MNCs) before and after concentration, colony-forming units (CFUs), and connective tissue progenitor cells (CTPs) after concentration were quantified. IC BMAC was injected at the site of RCR. A control cohort underwent RCR without BMAC. MRI analysis, dynamometer strength testing, range of motion, and ASES scores were assessed up to 12 months. Pre-centrifugation MNC counts were similar between HH and IC (17.4 vs. 13.4 MNC/mL, p = 0.18). After centrifugation, IC demonstrated higher MNC concentration (64.6 vs. 29.7 MNC/mL, p = 0.014). CFUs did not differ significantly (1896 vs. 1047, p = 0.17). Total CTPs were higher in IC (8338 vs. 3430, p = 0.035), although live CTPs were not significantly different (6013 vs. 2779, p = 0.054). No significant associations were found between the number CTPs or CFUs and tendon healing on MRI. IC yields greater CTPs than HH, supporting its role as a preferred BMA source. However, BMAC augmentation was not associated with measurable differences in tendon healing or clinical outcomes at 12 months, which may be due to the limited sample size. Further studies are needed to refine cell isolation and optimize BMAC protocols for RCR augmentation.