title: Repair of long-bone pseudoarthrosis with autologous bone marrow mononuclear cells combined with allogenic bone graft.
abstract: OBJECTIVE
  Long-bone pseudoarthrosis is a major orthopedic concern because of numerous factors such as difficulty of the treatment, high recurrence, high costs and the devastating effects on the patients' quality of life, which sometimes ends in amputation. Although the "gold standard" for the treatment of this pathology is autologous bone grafting, which has high osteogenic, osteoconductive and osteoinductive properties, this treatment presents some restrictions such as the limited amount of bone that can be taken from the patient and donor site morbidity. Bone marrow mononuclear cells (BM-MNCs) comprise progenitor and stem cells with pro-angiogenic and pro-osteogenic properties. Allogenic cancellous bone graft is a natural and biodegradable osteoconductive and osteoinductive scaffold. Combination of these two components could mimic the advantages of autologous bone grafting while avoiding its main limitations.
  
  
  METHODS
  Long-bone pseudoarthrosis was treated in seven patients with autologous BM-MNCs from iliac crest combined with frozen allogenic cancellous bone graft obtained from the tissue bank.
  
  
  RESULTS
  All patients showed complete bone consolidation 5.3 ± 0.9 months (range, 2-9 months) after cell transplantation. Moreover, limb pain disappeared in all of them. The mean follow-up was 35.8 ± 4.6 months after transplantation (range, 24-51 months) without pseudoarthrosis recurrence or pain reappearing.
  
  
  CONCLUSIONS
  Combination of autologous BM-MNCs and allogenic bone graft could constitute an easy, safe, inexpensive and efficacious attempt to treat long-bone pseudoarthrosis and non-union by reproducing the beneficial properties of autologous bone grafting while restricting its disadvantages.
authors: Unit of Spine Surgery & Pediatric Orthopedics, Department of Trauma and Orthopedic Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors: Ignacio
authors: I
authors: Fernandez-Bances
authors: Marcos
authors: M
authors: Perez-Basterrechea
authors: Silvia
authors: S
authors: Perez-Lopez
authors: Daniel
authors: D
authors: Nuñez Batalla
authors: Maria Angeles
authors: MA
authors: Fernandez Rodriguez
authors: Maria
authors: M
authors: Alvarez-Viejo
authors: Amaia
authors: A
authors: Ferrero-Gutierrez
authors: Yolanda
authors: Y
authors: Menendez-Menendez
authors: Jose Maria
authors: JM
authors: Garcia-Gala
authors: Dolores
authors: D
authors: Escudero
authors: Jose
authors: J
authors: Paz Aparicio
authors: Susana
authors: S
authors: Carnero Lopez
authors: Pedro
authors: P
authors: Lopez Fernandez
authors: Daniel
authors: D
authors: Gonzalez Suarez
authors: Jesus
authors: J
authors: Otero Hernandez
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D001854:Bone Marrow Cells / Q000166:cytology; D016026:Bone Marrow Transplantation; D016025:Bone Transplantation; D064987:Cell- and Tissue-Based Therapy; D005260:Female; D006801:Humans; D007963:Leukocytes, Mononuclear / Q000166:cytology; D008297:Male; D008875:Middle Aged; D011542:Pseudarthrosis / Q000473:pathology / Q000628:therapy*; D014184:Transplantation, Homologous