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Outcomes of iliac crest bone marrow aspirate injection for the treatment of recalcitrant Achilles tendinopathy

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Abstract

Background

Achilles tendinopathy is a common cause of posterior ankle and heel pain in both active and sedentary patients. Though the majority of patients respond to first-line non-operative management including activity modification, immobilization, orthotics, and physical therapy with stretching and eccentric strengthening, there is no consensus for patients who fail these treatments. We evaluate the role of iliac crest bone marrow aspirate (BMA) injections as a treatment option for recalcitrant cases.

Methods

A retrospective chart review was conducted of patients with refractory Achilles tendinopathy treated with iliac crest BMA concentrate injection. Symptoms were assessed using the numeric rating system (NRS) pain score at the pre-operative visit and at six, 12, 24, and 48 weeks postoperatively. Post-operative complications were recorded.

Results

A total of 15 patients (15 feet) with recalcitrant Achilles tendinopathy (5 insertional, 8 non-insertional, 2 combined) treated with iliac crest BMA concentrate injections were included in the study. Average age was 53.2 years (range, 25 to 64), average BMI was 27.1 kg/m2 (range, 18.4 to 34.4), and average duration of symptoms prior to BMA injection was 2.3 years (range, 1 to 7). Pre-operatively, average NRS was 6.26 (95% CI, 5.04 to 7.49), with significant improvement at six weeks (mean, 4.26; 95% CI, 2.94 to 5.59; p = 0.04), ten weeks (mean, 4.13; 95% CI, 2.91 to 5.35; p = 0.012), 24 weeks (mean, 3.40; 95% CI, 2.05 to 4.75; p = 0.03), and 48 weeks (mean, 2.60; 95% CI, 1.14 to 4.06; p = 0.007) post-operatively. Overall, there was trending improvement over the 48-week follow-up period, with a mean improvement in NRS of − 3.22 (95% CI, − 1.06 to − 5.38; p = 0.007) at final follow-up. There was no discernable difference between insertional and non-insertional tendinopathy, and there were no incidences of post-operative complications.

Conclusion

Iliac crest BMA appears to be a safe, effective, and potentially lasting treatment option for patients with intractable, insertional and non-insertional Achilles tendinopathy. Patients demonstrated and maintained statistically significant decrease in NRS pain score post-operatively with no complications at the donor or injection site.

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Data availability

All data available for this study was reported in the manuscript.

Code availability

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Authors and Affiliations

  1. Institute of Foot and Ankle Reconstruction, Mercy Medical Center, Baltimore, MD, USA

    Wisutthinee Thueakthong, Apiporn Garnjanagoonchorn, Guy Friedman, Harry Auster & Lew C. Schon

  2. Department of Orthopaedics, Georgetown School of Medicine, Washington, DC, USA

    Wisutthinee Thueakthong, Jonathan Day & Lew C. Schon

  3. Department of Physical Medicine and Rehabilitation, Bhumibol Adulyadej Hospital, 171 Phahonyothin Road, Khlong Thanon Subdistrict, Sai Mai District, Bangkok, 10220, Thailand

    Wisutthinee Thueakthong

  4. Department of Orthopaedics and Rehabilitation, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52240, USA

    Cesar de Cesar Netto

  5. Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA

    Eric Tan

  6. New York University Langone, New York, NY, USA

    Lew C. Schon

Authors
  1. Wisutthinee Thueakthong
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  2. Cesar de Cesar Netto
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  3. Apiporn Garnjanagoonchorn
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  4. Jonathan Day
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  5. Guy Friedman
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  6. Harry Auster
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  7. Eric Tan
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  8. Lew C. Schon
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Contributions

All authors contributed to the design of the study, literature review, data gathering and interpretation, manuscript writing, and editing.

Corresponding author

Correspondence to Cesar de Cesar Netto.

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Ethics approval

This study was approved by Institutional Review Board (IRB), under number MODCR00000491.

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All participants signed informed consent to participate in the study.

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All participants signed informed consent allowing publication of deidentified data.

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The authors declare no competing interests.

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Level of evidence: IV, case series

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Thueakthong, W., de Cesar Netto, C., Garnjanagoonchorn, A. et al. Outcomes of iliac crest bone marrow aspirate injection for the treatment of recalcitrant Achilles tendinopathy. International Orthopaedics (SICOT) 45, 2423–2428 (2021). https://doi.org/10.1007/s00264-021-05112-3

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  • DOI: https://doi.org/10.1007/s00264-021-05112-3

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