Anterior cruciate ligament tears treated with percutaneous injection of autologous bone marrow nucleated cells: a case series

Figures & data

Figure 1 ACL injection with fluoroscopy.

Abbreviation: ACL, anterior cruciate ligament.

Figure 2 ACL tracing and resulting histogram.

Abbreviations: ACL, anterior cruciate ligament; max, maximum; min, minimum; StdDev, standard deviation.

Table 1 NC count and volume injected for each patient

Patient	NC count (millions)	Volume injected (mL)
A	679	2.3
B	1123	4.8
C	375.6	2.6
D	567.8	2.2
E	716.3	2.4
F	841.5	3
G	1098	4
H	554.3	2
I	546.08	2.3
J	438.1	1.1
All patients (mean ± SD)	694±257	2.7±1

Abbreviations: NC, nucleated cell; SD, standard deviation.

Figure 3 MRIs and histograms for Patient H, (A) pre- and (B) at 3.5 months posttreatment.

Note: A darker improved ACL image was seen on the posttreatment MRI, as well as the leftward shift of pixels toward darker values in the graph.
Abbreviations: ACL, anterior cruciate ligament; max, maximum; min, minimum; MRI, magnetic resonance imaging; StdDev, standard deviation.

Figure 4 MRIs and histograms for Patient C, (A) pre- and (B) posttreatment.

Note: A darker improved ACL image was seen on the posttreatment MRI, as well as the leftward shift of pixels toward darker values in the graph.
Abbreviations: ACL, anterior cruciate ligament; max, maximum; min, minimum; MRI, magnetic resonance imaging; StdDev, standard deviation.

Figure 5 MRIs and histograms for Patient B, (A) pre- and (B) posttreatment.

Note: A darker improved ACL image was seen on the posttreatment MRI, as well as the leftward shift of pixels toward darker values in the graph.
Abbreviations: ACL, anterior cruciate ligament; max, maximum; min, minimum; MRI, magnetic resonance imaging; StdDev, standard deviation.

Table 2 Pre- to posttreatment histogram measurement change statistical analysis

Variable	Mean	SD	Median	Lower quartile	Upper quartile	Minimum	Maximum	P-value
Image mean	−12.911	14.699	−9.390	−18.962	−4.161	−46.373	1.459	0.0098
Image mode	−13.733	20.425	−9.167	−24.667	−4.333	−45.333	17.000	0.084
Image median	−12.367	14.358	−9.833	−18.333	0	−42.333	3.000	0.0195
Skewness	0.243	0.529	−0.024	−0.093	0.422	−0.292	1.204	0.625
Raw Integrated Density	−100783	77363	−71590	−163967	−48921	−244398	−3112	0.002

Note: P-values were calculated using the signed-rank test.

Table 3 Patient clinical outcomes

Patient	ACL tear grade	Likert % change	LEFS* pretreatment	LEFS posttreatment	Pain pretreatment	Pain posttreatment	Months postprocedure
A	3	70	40	64	5	3	6
B	2	100	41	79	4	0	6
C	2	100#	30	38	1	3	3
D	3	NA	53	NA	2	NA	NA
E	1	100	75	80	0	0	6
F	2	80	48	75	6	0	12
G	3	90	41	79	2	0	6
Patient	ACL tear grade	Likert % change	FRI* pretreatment	FRI posttreatment (12 mon)	Pain pretreatment	Pain posttreatment	Months postprocedure
H	3	100	22.5	2.5	0	0	24
I	1	40	NA	62	NA	3	3
J	3	100	NA	NA	NA	NA	18

Notes:

* FRI was scored on a scale of 0–100 (lowest is best function); LEFS was scored on a scale of 0–80 (highest is the best function);

# Likert reporting was missing at 3 months, but the patient reported 100% improvement at 12 months.

Abbreviations: ACL, anterior cruciate ligament; FRI, Functional Rating Index; LEFS, Lower Extremity Functional Scale; NA, not available.