What is bone marrow aspirate concentrate—the marrow drawn and spun for a joint shot?

What happens with bone marrow?

A licensed medical provider first draws marrow from the back or side of your pelvis. The marrow then goes into a centrifuge, which is a fast-spinning machine. The prepared marrow is put into the sore joint as a shot. Drawing the marrow can cause soreness, bruising, bleeding, or infection.

Small changes in drawing and spinning can alter the final mix. That variation isn't by itself a safety or quality warning. It means one clinic's marrow shot may differ from another clinic's shot. Ask where the marrow comes from and who performs each part.

How is platelet-rich plasma, or PRP, different?

Platelet-rich plasma, or PRP, is made by putting blood from your arm in a spinning machine that separates the part holding more platelets. Platelets are small blood pieces that carry proteins used in normal healing. The provider uses the separated part for your joint shot. This shot begins with blood rather than marrow.

Concentrated PRP contains a higher amount of platelets than another PRP mix. A higher amount doesn't prove the shot will work better. The aching joint, its diagnosis, and the way PRP is prepared can affect the result. Ask why one kind is being offered after your exam.

What does QC Kinetix offer?

Regenerative treatments at QC Kinetix are office shots made with material collected from your own blood or marrow. The provider puts the shot inside the aching joint to try to make movement easier and reduce soreness. It can't promise relief, and it doesn't tell you why the joint hurts. The exam still comes before your choice.

Medical providers are licensed clinic staff who examine you and perform the work. Ask whether a doctor, a nurse, or another licensed professional will see you. Ask how the collected material will be prepared. Then decide how much relief would make the care worthwhile for you.

Sources

1. The International Society for Cell & Gene Therapy position statement holds that the acronym MSC should mean mesenchymal STROMAL cells and should only be called stem cells where rigorous in vitro and in vivo evidence of stemness exists for that specific preparation.

   Viswanathan S, et al. — Mesenchymal stem versus stromal cells: International Society for Cell & Gene Therapy (ISCT®) Mesenchymal Stromal Cell committee position statement on nomenclature. Cytotherapy, 2019. DOI: 10.1016/j.jcyt.2019.08.002.

2. The 2018 AAOS/NIH consensus work group recommended that minimally manipulated mixed cell preparations be called CELL THERAPY rather than stem cell therapy, and that their untested and uncharacterised nature be clearly communicated to patients and the public, because stem cells have properties these preparations do not meet.

   Chu CR, et al. — Optimizing Clinical Use of Biologics in Orthopaedic Surgery: Consensus Recommendations From the 2018 AAOS/NIH U-13 Conference. J Am Acad Orthop Surg, 2019. DOI: 10.5435/JAAOS-D-18-00305.

3. Mesenchymal stromal cells make up only about 0.001 to 0.01 percent of the nucleated cells in bone marrow, so the harvesting and processing technique - aspiration site, syringe size, centrifuge speed and time - materially determines what ends up in the syringe, and no consensus protocol exists.

   Jeyaraman M, et al. — Impact of the Process Variables on the Yield of Mesenchymal Stromal Cells from Bone Marrow Aspirate Concentrate. Bioengineering (Basel), 2022. DOI: 10.3390/bioengineering9020057.

4. A 2023 appraisal of 15 randomized and 11 non-randomized trials of culture-expanded MSCs for knee osteoarthritis found function improved relative to control in 11 of 15 RCTs and cartilage protection or repair reported in 18 of 21 imaging studies, but noted the total sample of 610 patients limits any definitive conclusion.

   Copp G, et al. — Culture-expanded mesenchymal stromal cell therapy: does it work in knee osteoarthritis? A pathway to clinical success. Cell Mol Immunol, 2023. DOI: 10.1038/s41423-023-01020-1.

5. 21 CFR 1271.10(a) sets the four criteria a human cell or tissue product must meet to be regulated SOLELY under section 361 of the Public Health Service Act: it must be minimally manipulated; intended for homologous use only, as reflected by labeling and advertising; not combined with another article beyond water, crystalloids or a preserving agent; and either have no systemic effect and not depend on the metabolic activity of living cells, or else be for autologous use, use in a close blood relative, or reproductive use.

   US Code of Federal Regulations, Title 21 — 21 CFR 1271.10 - Are my HCT/P's regulated solely under section 361 of the PHS Act. , 2004.

6. On 27 September 2024 the Ninth Circuit held in United States v. California Stem Cell Treatment Center that stromal vascular fraction produced by enzymatically digesting a patient's own fat IS a drug under the Federal Food, Drug, and Cosmetic Act, and that the same surgical procedure exception does not apply because the removed fat and the implanted SVF are not the same thing. The district court's ruling for the clinics was reversed.

   United States Court of Appeals for the Ninth Circuit — United States v. California Stem Cell Treatment Center, Inc., No. 22-56014 (9th Cir. Sept. 27, 2024). , 2024.

7. A phase III double-blind placebo-controlled trial in 261 patients with Kellgren-Lawrence grade 3 knee osteoarthritis tested a single injection of autologous culture-expanded adipose-derived mesenchymal stem cells - a product that cannot legally be sold outside a clinical trial in the United States because culture expansion is more than minimal manipulation.

   Kim KI, et al. — Clinical Efficacy and Safety of the Intra-articular Injection of Autologous Adipose-Derived Mesenchymal Stem Cells for Knee Osteoarthritis: A Phase III, Randomized, Double-Blind, Placebo-Controlled Trial. Am J Sports Med, 2023. DOI: 10.1177/03635465231179223.

8. A retrospective comparison of 523 bone marrow aspiration procedures against 435 open iliac crest bone graft harvests found aspiration significantly reduced complications - relevant because marrow aspiration for a joint injection is a real procedure with a real, if low, complication rate.

   Hernigou P, et al. — Morbidity of graft harvesting versus bone marrow aspiration in cell regenerative therapy. Int Orthop, 2014. DOI: 10.1007/s00264-014-2318-x.