Autologous bone marrow aspirate as a standalone treatment in patients with impaired fracture healing: A scoping review.

INTRODUCTION: Fracture nonunion develops in 5-10% of all fractures and the industry offers biological grafting solutions to address this. Autologous bone marrow aspirate (BMA) may represent an inexpensive alternative, minimally invasive, biologically active adjunct to surgery.

OBJECTIVE: This scoping review aimed to analyze the current evidence on the effectiveness and safety of autologous bone marrow aspirate as a standalone treatment in patients with impaired fracture healing (minimum 3 months post-fracture).

METHODS: The data was extracted from Embase, Medline, Cochrane Library, Web of Science, and ClinicalTrials.gov, up to October 30, 2024, and conducted according to the Joanna Briggs Institute Scoping Review Manual and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Randomized controlled trials, non-randomized trials, prospective or retrospective cohort studies, and case series with a minimum of five participants were included. Studies had to report on BMA as a standalone treatment for nonunion and assess at least one outcome related to effectiveness (ex: time to union, radiographic healing, etc.). Two members of the research team independently carried out the screening, selection, and data extraction processes, with a third member resolving any discrepancies. Descriptive data were presented in tabular form, while other findings were synthesized descriptively.

RESULTS: Four hundred and sixty-nine articles were found, 55 met the inclusion criteria and 14 were included after full-text review (311 patients) Union rates ranged from 50% (3/6 patients) to 100%, with most studies reporting rates above 80%, within 1.5-10 months. Reported volume and density of injected BMA varied. There were no serious complications or donor-site morbidity.

CONCLUSION: While union rates are encouraging, the absence of control groups across all included studies means that the contribution of BMA to these outcomes cannot be determined. Functional outcomes were not often assessed, and study heterogeneity limits a broader generalization. Defining the concentration and BMA volume needed appears as a next step to validate its effectiveness and guide clinical use, along with adequate control groups.

LEVEL OF EVIDENCE: V.