Ultrasound-guided needle placement for bone marrow aspiration of the anterior iliac crest

Introduction: Bone marrow aspirate concentrate (BMAC) use has increased for both primary treatment and as a surgical adjunct of several other musculoskeletal conditions such as degenerative joint disease and rotator cuff tears. Bone marrow harvest, when performed as part of musculoskeletal treatment or in conjunction with orthopedic surgery is commonly performed at the anterior iliac crest. No technique for ultrasound guidance has been validated at the anterior iliac crest. Objectives: Here we describe a novel approach for bone marrow aspiration at the anterior iliac crest utilizing ultrasound guidance to facilitate safe needle placement using a human cadaveric model. Methods: Using cadaver hemipelvises, needle placements were attempted along the anterior iliac crest via ultrasound guidance and latex dye was used to mark the site of cortical penetration. Results: A total of 39 cortical penetrations were attempted on 8 iliac crests. Needle placements were accurately placed on the crest under ultrasound guidance as confirmed by dissection of the relevant anatomy and confirmation of colored dye within the cortical penetration. Conclusion: Ultrasound can be used as a valuable tool for image guidance during bone marrow needle placement along the anterior iliac crest. This technique for initial needle placement at the anterior iliac crest is safe and feasible for providers with skill in ultrasound guided needle placement to assist with localization along safe zones for quality bone marrow cellular harvest.