The triad of osteobiology – Rehydrating calcium phosphate with bone marrow aspirate concentrate for the treatment of bone marrow lesions

The topic of bone marrow lesions has been more widely discussed in recent years, especially in the knee literature. One such procedure to treat this pathology is back-filling the lesion with bone substitute materials, calcium phosphate (CaP), as just one example. This technique uses the principle of osteoconduction, CaP mimicking the composition of subchondral bone and creating a scaffold for bone cells to integrate onto and promote internal cancellous bone healing. After performing this procedure on the foot and ankle as the protocol describes, a technique was developed to increase healing potential by adding concentrated bone marrow aspirate (BMA) to the CaP. This addition in theory gives us increased osteobiology properties – osteogenesis, osteoconduction, and possibly osteoinduction through growth factors like transforming growth factor beta (TBF-β) and vascular endothelial growth factor (VEGF). Based off of other reported literature, this technique has theoretical benefit in the operating room to increase patient results. Here the method is discussed with a case example.