Dry Tap During Bone Marrow Aspiration for Musculoskeletal Treatments: Case Report and Proposed Management Algorithm

Bone marrow concentrate injections, orthobiologic treatments utilized for musculoskeletal diseases, are increasingly used by interventional pain management physicians, sports medicine physicians, and other musculoskeletal specialists. A rarely discussed yet clinically important is the "dry tap," in which no marrow is obtained during aspiration. Although well-documented in the hematology-oncology literature, its significance and management in otherwise healthy patients remain unclear.

We present the case of a dry tap occurring during the in-office bone marrow aspiration of a patient with knee osteoarthritis who had no hematologic or oncologic history. This case prompted a multidisciplinary evaluation and highlighted the clinical uncertainty this issue presents for interventional pain management.

We reviewed the relevant literature. We propose a practical management algorithm developed in collaboration with hematology-oncology and sports medicine specialists. This approach may assist physicians to effectively deal with a dry tap during an orthobiologic procedure.