Confronto tra l'impiego di midollo osseo concentrato, matrice ossea demineralizzata e PRF e le cellule mesenchimali espanse e granuli di calcio fosfato nel trattamento dei ritardi consolidazione

Objective To determine the effectiveness of percutaneous injection of expanded bone marrow-derived mesenchymal stromal cells associated with biphasic calcium phosphate biomaterials versus autologous bone marrow concentrated, demineralized bone matrix, and platelet rich fibrin in the treatment of long bone non-unions. Materials and Methods From January 2008 to January 2017, 30 patients with non-union of the lower limbs who were on the waiting list for open grafting with established tibial or femoral non-union and minimal deformity were eligible to participate in this study. Patients were divided into two groups. Twenty-three patients were treated with a single injection of autologous concentrated bone marrow, demineralized bone matrix, and platelet rich fibrin (Group 1), and 7 patients with a single injection of expanded bone marrow-derived mesenchymal stromal cells associated with biphasic calcium phosphate biomaterials (Group 2). Results Our study group comprised 30 patients (17 males and 13 females; mean age 42, range 17 to 73). Non-unions were located in the femur (18 cases) and in the tibia (12 cases). Clinical and imaging follow-up ranged from 4 to 62 months (mean 21 months). Bone union occurred in 17 out of 23 patients (73%) on an average of 12 months (range 3 to 36) into the Group 1, and 8 out of 8 (100%) on an average of 6 months (range 3 to 8) into Group 2. No patients presented complications until the end of the follow-up. Conclusion Percutaneous injection of expanded bone marrow-derived mesenchymal stromal cells associated with biphasic calcium phosphate biomaterials is an effective treatment for long-bone non-unions. This technique allows to get bone healing with a minimal invasive approach and with a hospitalization of 2 days. Key elements of bone regeneration consist of a combination of biological and biomechanical therapeutic approach.