Emerging Options for Biologic Enhancement of Stress Fracture Healing in Athletes

Timothy L. Miller, MD; Christopher C. Kaeding, MD; Scott A. Rodeo, MD

Disclosures

J Am Acad Orthop Surg. 2020;28(1):1-9. 

In This Article

Injectable Bone Graft Substitutes

The utility of injectable bone graft substitutes for stimulating healing of stress fractures, insufficiency fractures, and nonunions in humans is currently under investigation. This option includes a combination of concentrated bone marrow aspirate and demineralized bone matrix injected into a fracture site. The technique uses the osteogenic properties of BMAC combined with the osteoconductive potential of bone matrix to stimulate healing and fracture callus formation.[25] An example of this option, Intraosseous BioPlasty(Arthrex), involves percutaneously performing a core decompression of the affected metaphyseal bone site and injecting a mixture of bone marrow concentrate, calcium chloride clot, and demineralized bone matrix (Figure 3). It has been used in combination with arthroscopy to stimulate healing of subchondral bony defects of the tibia and is currently used in the distal femur and proximal tibia for subchondral insufficiency fractures.[26] This option is not recommended in the diaphyseal region of long bones, and the appropriate indications and long-term outcomes of these treatment options are yet to be determined.

Figure 3.

Intraoperative photograph showing (A) injection of a mixture of concentrated bone marrow aspirate and demineralized bone matrix at the proximal tibial metaphysis. Intraoperative anterior-posterior fluoroscopy image showing (B) injection of a mixture of concentrated bone marrow aspirate and demineralized bone matrix at the proximal tibial metaphysis through a fluted cannula. A core decompression of the proximal tibial metaphysis has been performed before injection.

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