Bone marrow concentrate, or BMAC, is an injection made from marrow drawn from the back of your pelvis, concentrated the same day and placed into a damaged joint, tendon or the bone below the joint. In St. Louis, we do it in one office visit under local anesthetic. It suits advanced arthritis and bone marrow lesions.
Your pelvis is a warehouse. The marrow inside the back of the hip bone holds the most concentrated supply of repair cells you own, along with platelets and the signals that coordinate healing. When a joint has moved past the stage where a short repair shift helps, we go to that warehouse.
If platelets are the repair workers, bone marrow cells are the general contractor. They read the damage, call in the right crews, and keep the job running after the first wave leaves.
You lie face down. We numb the skin and the bone surface over the back of the pelvis, just above the buttock, and use imaging to guide a needle into the marrow space. You feel pressure and a brief pulling sensation during the draw. You are awake, there is no sedation, and most patients drive themselves home. The marrow goes straight into an FDA-cleared system that spins it down to concentrate the cells and platelets.
Bone marrow concentrate works as a general contractor. The cells in it release signals that calm the destructive inflammation inside an arthritic joint, protect the cartilage cells that remain, and direct local tissue to repair. It also carries platelets, so it brings its own repair workers to the site. In head-to-head knee trials, BMAC and PRP both outperformed hyaluronic acid, with no clear gap between them. A 2024 review of eight randomized trials found BMAC improved pain and function from the first month with no serious adverse events, and a separate 2024 analysis found its complication rate matched other common knee injections.
We match the product to the tissue, the stage of damage and the patient.
Sometimes we combine them, for example BMAC into the bone under the joint and PRP into the joint space during the same visit. The decision comes from your exam, your imaging and your history.
Cartilage has no nerves. Much of arthritis pain comes from the bone beneath it, where swollen, overloaded bone shows up on MRI as a bone marrow lesion. Three forces feed it. Insulin resistance and chronic inflammation weaken the bone’s repair and leak inflammatory chemistry into the joint. Poor sleep strips away the overnight repair window. Load pounds the same spot with every step when body weight is high or the thigh muscles are weak. Then the behavior and economics: a job that keeps you sitting, a food supply engineered to be cheap and inflaming, and no time to rebuild strength. Treat only the joint and the bone keeps sending pain.
That is why lifestyle and behavior are 40 to 50 percent of our protocol. Metabolic optimization, rehabilitation and laser therapy protect what the injection starts. Learn more about metabolic inflammation and chronic pain.
The procedure is done at our office at 4477 Woodson Rd in St. Louis. Expect a sore, bruised spot at the back of the pelvis for several days and soreness in the treated joint. Protect the area for the first few days and follow the rehab plan. Some patients feel better in three weeks; others need a second or third treatment, decided by how the tissue responds. You can’t make a carrot grow faster than it grows.
We numb the skin and the surface of the bone. Most people describe deep pressure and a brief pulling feeling, then soreness for a few days.
No. It is not billed to insurance. That is a payer budgeting decision. HSA and FSA funds are generally eligible.
No. The harvest and the injection are both done under local anesthetic while you are awake, and most patients drive themselves home.
In knee trials they perform about the same. BMAC earns its place in advanced disease, in the bone below the joint, and after PRP has fallen short.
For many patients it delays surgery. Dr. Padda is a licensed physician and surgeon, and when surgery is the right answer, we say so.
Most patients notice a trend over the following weeks. We recheck function and decide on next steps together.
If you were told your joint is too far gone for anything but surgery, ask about bone marrow concentrate first. See every option on our orthobiologics in St. Louis page. Over 90% of our accepted case-study patients see significant improvement. These are practice-reported figures from our own population, not trial outcomes, and individual results vary. Request the free orthobiologics guide above, or call (314) 481-5000 to find out whether you are a candidate.
Prefer not to fill in a form?
Same-day and emergency appointments are available.