Bone Marrow Aspirate Treatment for the Hip’s Torn Labrum

Bone marrow concentrate (BMAC) contains stem cells and can help facilitate healing in various orthopedic tissues. This post will discuss hip labral tears, common treatments, and how BMAC can help heal hip labral tears and associated injuries.

What Is a Hip Labral Tear?

The hip labrum is a ring of fibrocartilage attached to the socket of the hip, or acetabulum. It provides stability and deepens the joint. The hip labrum is susceptible to injury and can tear. Tears are thought to be from gradual wear and tear, trauma, congenital malformation (dysplasia), impingement, and joint laxity.¹

Pain from a labral tear can start suddenly or develop gradually. The pain is usually in the front of the hip or groin but may radiate to the buttocks side of the hip or down the front of the leg. 

It is usually made worse with walking, pivoting, running, and prolonged sitting, which can all dramatically affect a person’s quality of life. 

Labral tears are classified by their location in the hip, how they look (their morphology), and if they may be detached or not.

Anterior Hip Labral Tear

The labrum is wider and thinner at the front. This is the most common area of labral tears and typically causes pain at the front of the hip and in the groin. Anterior superior (top) area tears cause the most pain.

Posterior Hip Labral Tear

The labrum is thicker at the back of the hip. Tears here are less common and when they do occur they may cause more buttock area pain.

Superior Labral Tears

These are tears on the top and outside part of the labrum.

Common Treatment Options For Hip Labral Tears

When you first experience hip pain or are diagnosed with a labral tear, you may just try at-home remedies.

Activity Modification

The simplest thing you can do for hip labral pain is just to avoid the activities that cause pain. Typically, these are high-impact activities like running or jumping or activities that require deep flexion or rotation of the hip.

Hot and Cold Applications

Heat can help provide some muscle relaxation and blood flow to the area and may help reduce the pain. Infrared heat can provide deeper, penetrating heat, which is good for blood flow and metabolism closer to the labrum.

Ice can reduce swelling and soreness, but ice can inhibit blood flow and healing, so you don’t want to ice for longer than a few minutes at a time.

Medications – NSAIDs

Non-steroidal anti-inflammatory drugs such as ibuprofen and Aleve may be used to help with pain and inflammation.

However, while these drugs can help alleviate pain and symptoms temporarily, they carry many risks. They can inhibit healing or make you more prone to further injury. They are known to increase the risks of stomach bleeds, heart attack and stroke, kidney injury, bone loss, decreased testosterone, and chronic pain.

Physical Therapy

If home remedies don’t help, then a good physical therapist can evaluate your posture, alignment, symmetry, and muscle function and develop an exercise and mobility program to address imbalances. They also can do modalities that can help loosen tight muscles, reduce pain, improve hip motion, and reduce the stress on the labrum. 

There is little risk to physical therapy.

When a Regenerative Method Is More Ideal

When conservative measures fail, surgery is no longer the only other option. There are ways to stimulate labral tears to heal themselves via injections of orthobiologics that are less invasive and less risky than surgery.

Orthobiologics are naturally derived substances that can heal orthopedic tissue. One of the most powerful orthobiologics that can help orthopedic injuries heal, including labral tears, is bone marrow aspirate concentrate (BMAC).

What Is Bone Marrow Aspirate Concentrate (BMAC)?

BMAC or bone marrow aspirate concentrate contains stem cells and is obtained by taking bone marrow from the iliac crest (hip bone) safely and comfortably. The bone marrow is processed to concentrate the cells in the marrow. There are many important and helpful healing cells in bone marrow, and stem cells are believed to be the most potent.

Benefits of Bone Marrow Aspirate Concentrate as a Treatment Option

At the Centeno Schultz Clinic, we were the first doctors in the world to inject stem cells for orthopedic injuries. Since then, we have been researching and creating procedures to help utilize orthobiologics such as BMAC to the fullest of their capabilities.

To optimize BMAC treatments, there are several details we must ensure to get the best product and outcomes.

• Obtaining the bone marrow: The safest and most abundant source of stem cells is from the posterior iliac crest. Based on the research, to obtain the most stem cells, multiple small aspirations are needed. 
  
  Many clinics may just take a large amount of marrow from one site. That may save the physician time, but it dramatically reduces stem cells because after a small amount of aspirate is taken, the rest is peripheral blood that is poor in stem cells. 
• Concentration: Next, we want to obtain the most stem cells from the aspirate as possible and concentrate those cells. While most clinics have a simple bedside machine to do this, we have a personalized laboratory staff to process the bone marrow more efficiently. 
  
  We also have a patented technique to get a second fraction of stem cells that all simple machines miss. We can typically concentrate stem cells five to ten times better than a bedside machine.
• Placement: Lastly, the doctor must place the cells accurately and safely in the damaged labrum for optimal results. We invented many of the procedures used to inject BMAC. We always use image guidance with ultrasound and/or X-ray to achieve this. 

Also important for successful outcomes is having a doctor who is a musculoskeletal specialist (specialists in PMR, sports medicine, pain medicine, a few orthopedic surgeons, and a few interventional radiologists), trained to correctly diagnose non-surgical orthopedic problems and with training in image review and regenerative medicine to know what the best treatment options are. 

BMAC also has a growing number of research publications that expand each year.

How Is BMAC Treatment Used for Hip Labral Tears?

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What You Can Anticipate During a Bone Marrow Aspiration

Many patients may have some anxiety around a bone marrow aspiration but most patients report that it was better than they expected. When done appropriately, it’s a relatively easy, minimally painful, low-risk procedure.

Preparing Yourself for the Procedure

Make sure you are well hydrated in the days leading up to a bone marrow aspiration or blood draw. You should be fasting for six hours prior to the procedure, but you can drink clear fluids up to two hours before.

What Happens During the BMA Procedure

If you have mild anxiety or reservations about the procedure, you may be given an oral anti-anxiety medication such as valium 45 minutes before the procedure. If you are more anxious, you may be given IV anesthesia to make you more sedated. For the procedure, you will be lying on your stomach.

Oxygen will be given through a nasal cannula. You will have an oxygen, heart rate monitor and blood pressure cuff placed to monitor your vital signs. Your posterior hip/buttocks area will be cleaned and draped in surgical fashion. Your doctor will use ultrasound to administer a local anesthetic to the area.

Once the anesthesia settles in, a specialized needle called a trocar will be used to access the bone and aspirate 5-10cc of marrow from each of multiple sites along the bone. Most patients feel only a mild ache or odd sensation with the aspiration and are mostly comfortable.

Post-Procedure Guidelines

After the procedure, bandages will be placed, which are to remain on for 72 hours. You can shower after 12 hours, but you should not immerse the site in water for 72 hours. Most patients may have some minimal soreness in the area that rarely needs any treatment. If needed, you can apply ice to the area or take a Tylenol for mild discomfort.

After-Care

Keep the site clean and dry and the bandages can be removed after three days. You should avoid strenuous activity for one or two days.

Are There Risks with BMAC?

BMAC procedures are very safe. No procedure is risk-free so, as with any injection, there are small risks of infection, bleeding, bruising, pain at the site, or potential damage to nearby sensitive tissues. We have published the largest study on safety with BMAC that did not show any risks of cancers or serious adverse events with these procedures. It was a multi-center analysis of adverse events among 2,372 adult patients undergoing adult autologous stem cell therapy for orthopedic conditions: PubMed (nih.gov).

Discover Optimal Treatment for Your Condition Today

Labral tears can be incredibly debilitating, but there are non-invasive ways to help them heal. At the Centeno-Schultz Clinic, we provide cutting-edge regenerative medicine solutions for symptomatic labral tears.

Our expertise in musculoskeletal and regenerative medicine allows us to use bone marrow concentrate treatments, which harness the power of stem cells to treat labral tears and a variety of orthopedic issues. 

Our goal is to help you get back to doing what you love without resorting to risky drugs or invasive surgeries.

Are you a Candidate?

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Christopher J. Centeno, MD

Christopher J. Centeno, M.D. is an international expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate in orthopedics. He is board-certified in physical medicine and rehabilitation with a subspecialty of pain medicine through The American Board of Physical Medicine and Rehabilitation. Dr. Centeno is one of the few physicians in the world with extensive experience in the culture expansion of and clinical use of adult bone marrow concentrate to treat orthopedic injuries. His clinic incorporates a variety of revolutionary pain management techniques to bring its broad patient base relief and results. Dr. Centeno treats patients from all over the US who…

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John Schultz, MD

John R. Schultz M.D. is a national expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate for orthopedic injuries. He is board certified in Anesthesiology and Pain Medicine and underwent fellowship training in both. Dr. Schultz has extensive experience with same day as well as culture expanded bone marrow concentrate and sees patients at the CSC Broomfield, Colorado Clinic, as well the Regenexx Clinic in Grand Cayman. Dr. Schultz emphasis is on the evaluation and treatment of thoracic and cervical disc, facet, nerve, and ligament injuries including the non-surgical treatment of Craniocervical instability (CCI). Dr. Schultz trained at George Washington School of…

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John Pitts, M.D.

Dr. Pitts is originally from Chicago, IL but is a medical graduate of Vanderbilt School of Medicine in Nashville, TN. After Vanderbilt, he completed a residency in Physical Medicine and Rehabilitation (PM&R) at Emory University in Atlanta, GA. The focus of PM&R is the restoration of function and quality of life. In residency, he gained much experience in musculoskeletal medicine, rehabilitation, spine, and sports medicine along with some regenerative medicine. He also gained significant experience in fluoroscopically guided spinal procedures and peripheral injections. However, Dr. Pitts wanted to broaden his skills and treatment options beyond the current typical standards of care.

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Jason Markle, D.O.

Post-residency, Dr. Markle was selected to the Interventional Orthopedic Fellowship program at the Centeno-Schultz Clinic. During his fellowship, he gained significant experience in the new field of Interventional Orthopedics and regenerative medicine, honing his skills in advanced injection techniques into the spine and joints treating patients with autologous, bone marrow concentrate and platelet solutions. Dr. Markle then accepted a full-time attending physician position at the Centeno-Schultz Clinic, where he both treats patients and trains Interventional Orthopedics fellows. Dr. Markle is an active member of the Interventional Orthopedic Foundation and serves as a course instructor, where he trains physicians from around the world.

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Brandon T. Money, D.O., M.S.

Dr. Money is an Indiana native who now proudly calls Colorado home. He attended medical school at Kansas City University and then returned to Indiana to complete a Physical Medicine and Rehabilitation residency program at Indiana University, where he was trained on non-surgical methods to improve health and function as well as rehabilitative care following trauma, stroke, spinal cord injury, brain injury, etc. Dr. Money has been following the ideology behind Centeno-Schultz Clinic and Regenexx since he was in medical school, as he believed there had to be a better way to care for patients than the status quo. The human body has incredible healing capabilities…

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Reference:

1. Rampal S, Jaiman A, Tokgöz MA, Arumugam G, Sivananthan S, Singh RSJ, Zazali SB, Mohaddes M. A review of the efficacy of intraarticular hip injection for patients with hip osteoarthritis: To inject or not to inject in hip osteoarthritis? Jt Dis Relat Surg. 2022;33(1):255-262. doi: 10.52312/jdrs.2022.402. Epub 2022 Mar 28. PMID: 35361105; PMCID: PMC9057559.