Bone marrow concentrate — your own cells and signals, concentrated.
BMAC: marrow-derived cells and growth factors, image-guided into the structures that need them — autologous, judiciously applied.
What is BMAC?
Bone marrow concentrate is drawn from your own marrow and concentrated to gather the regenerative cells and signaling molecules it carries. Because it’s autologous, it works with your biology and introduces nothing foreign. But how the marrow is drawn changes what ends up in the concentrate — which is why the harvest technique matters as much as the material itself.
How the marrow is drawn
How the marrow is drawn changes what ends up in the concentrate. Dr. Paul uses a modified Hernigou technique to recover more of the marrow’s regenerative cells and less of the peripheral blood that dilutes them — an approach he has published on. He also helped develop a dedicated bone-marrow aspiration needle, rather than the standard Jamshidi needle most practices carry over from hematology and oncology. The placement is then ultrasound-guided — a technique Dr. Paul has practiced for more than fifteen years — so the concentrate reaches the exact structure that needs it.
What it treats
This is orthopedic BMAC — used for stubborn joints and certain tendon and ligament problems, often where simpler options haven’t held. It’s considered most often for osteoarthritis of the larger joints, especially the knee and hip. An evaluation determines whether it’s the right tool for your injury.
Held to a published standard
Dr. Paul served on the SAFE expert panel on bone-marrow aspirate guidelines — the standards for how marrow concentrate is safely and responsibly collected and used — and he has published repeatedly in regenerative orthopedics.
Chosen carefully, done to a standard
BMAC is one of the most powerful options in regenerative orthopedics — and its power depends almost entirely on the hands running it. Dr. Paul holds the harvest, the concentration, and the placement to the published standards he helped write. He is equally deliberate about who it is for: the evidence is stronger for some conditions than others, so selection carries as much weight as the biology. Chosen well and done well, it does more than anything else in the toolkit.
The marrow draw is the part patients ask about most, and it is planned for as carefully as the harvest itself. The site is numbed with local anesthetic, and nitrous oxide, oral sedation, and advanced regional and specific peripheral nerve blocks are available — an approach few physicians offer. Breath work, meditation, and procedural music tuned to 528 Hz are part of the same plan. The experience is far easier than patients expect.
Common questions
Asked and answered
What is bone marrow concentrate (BMAC)?
BMAC is drawn from your own marrow and concentrated to gather the regenerative cells and growth factors it carries. Because it’s autologous, it introduces nothing foreign.
How is the marrow taken — and does it hurt?
The marrow is typically drawn from the back of the pelvis (the iliac crest) through a small needle, with local anesthetic to numb the area. Dr. Paul uses a purpose-built aspiration needle and a modified Hernigou technique that recovers more regenerative cells than a standard draw. Most people feel pressure rather than sharp pain during the aspiration, with some soreness at the site afterward.
How long does the procedure take?
The aspiration and concentration are done in a single office visit. The draw itself is quick; preparing and placing the concentrate adds time, so plan for the appointment rather than a few minutes.
What is BMAC used for?
Orthopedic problems — most often osteoarthritis of larger joints like the knee and hip, and certain tendon and ligament injuries that haven’t responded to first-line care. It’s chosen where the diagnosis supports it.
Is BMAC covered by insurance?
For orthopedic use, BMAC is generally considered elective and is usually not covered by insurance or Medicare. Cost is discussed openly at your evaluation.
Does BMAC work?
For the right problem in the right hands, BMAC can do a great deal. Dr. Paul offers it where the diagnosis supports it and holds the harvest, concentration, and placement to a published standard. The evidence is stronger for some conditions than others, so careful patient and injury selection is part of why it works.
Dr. Paul in the literature
Selected peer-reviewed work
- Paul RV, contributing author. Regenerative Medicine in Spine and Joint Pain — standardizing ultrasound-guided injection techniques, PRP parameters, and bone-marrow-concentrate harvesting.
- Everts PA, Malanga GA, Paul RV, Rothenberg JB, Stephens N, Mautner KR. Assessing clinical implications and perspectives of the pathophysiological effects of erythrocytes and plasma free hemoglobin in autologous biologics for musculoskeletal regenerative medicine therapies. Regen Ther. 2019;11:56–64. doi.org/10.1016/j.reth.2019.03.009
Educational information, not medical advice or a diagnosis. Care is individualized; not every treatment is right for every patient, and results vary.