Your Body Has the Ability to Heal Itself. BMAC Helps It Do That.
Bone marrow aspirate concentrate — BMAC — is one of the most powerful regenerative treatments available in orthopedic medicine today. It harnesses the healing potential already present inside your own body, concentrates it using the most advanced processing technology on the market, and delivers it precisely to the site where healing is needed most.
Dr. Raffy Mirzayan uses BMAC both as a standalone treatment for arthritis and soft tissue conditions, and as a surgical adjunct — applied directly at the repair site during rotator cuff repair, ACL reconstruction, and meniscus repair to enhance healing and reduce the risk of failure. It is one of the most important tools in his practice, and one of the most meaningful services he offers his patients.
If you have been told that your body cannot heal a torn tendon, that your cartilage is too damaged to recover, or that surgery alone is your only option — BMAC may change that conversation entirely.
Call (310) 746-5918 to schedule a consultation.
What Is BMAC?
Bone marrow is the richest source of regenerative cells in the human body. Found inside the core of your bones, bone marrow contains a concentrated population of cells and growth factors that play a central role in tissue repair, new blood vessel formation, and the regulation of inflammation. These are the same biological signals your body relies on to heal after injury.
BMAC is created by aspirating a bone marrow blood and fat from the patient's own body, processing it in a centrifuge to concentrate the regenerative cells and growth factors, and delivering that concentrate to a target site — either by injection or by direct application during surgery. Because it comes entirely from your own body, there is no risk of rejection or allergic reaction.
It is important to understand that BMAC is not a drug, is not a foreign substance, and does not involve any manipulation of cells outside the body. It is your own biology — concentrated and redirected.
Note: In accordance with FDA guidelines, Dr. Mirzayan does not make claims regarding stem cells in the context of BMAC therapy.
The Arthrex Angel System: Precision Processing for Maximum Potency
The quality of BMAC depends entirely on how it is processed. Dr. Mirzayan uses the Arthrex Angel system — the same platform he uses for PRP — which is widely regarded as the most advanced biologic processing technology available in orthopedic practice.
Unlike standard centrifuge-only systems, the Angel system incorporates a flow cytometer — an optical sensor that uses specific wavelengths of light to detect and precisely separate plasma, regenerative cells, and red blood cells in real time. This allows the machine to automatically divert each component into the correct compartment, producing a BMAC product that is highly concentrated, reproducible, customized and tailored to the specific needs of each patient.
The result is a concentrate that is measurably superior to what standard processing systems can produce — which matters enormously when the goal is to stimulate meaningful biological healing.
How Dr. Mirzayan Uses BMAC: Standalone and Surgical
One of the ways that distinguishes Dr. Mirzayan's approach to BMAC is the breadth and precision of how he applies it. He uses BMAC in two distinct ways:
As a Standalone Treatment
For patients who are not yet surgical candidates, or who want to explore every biologic option before committing to an operation, BMAC can be injected directly into the affected joint or tissue. Dr. Mirzayan uses standalone BMAC most commonly for:
- Knee osteoarthritis — to reduce pain, improve function, and slow the progression of cartilage degeneration
- Shoulder arthritis — for patients who want to preserve the joint and delay or avoid replacement
- Rotator cuff tendinopathy and partial tears — to stimulate healing of damaged tendon tissue
- Meniscus conditions — to support healing in patients with degenerative meniscus tears
BMAC is not appropriate for every patient. Dr. Mirzayan will evaluate your imaging, your symptoms, and your overall clinical picture before recommending it, and he will be direct with you if he believes a different treatment is better suited to your situation.
As a Surgical Adjunct
This is where BMAC becomes particularly compelling. Dr. Mirzayan routinely applies BMAC directly at the repair site during surgery — augmenting the biological environment at the exact moment when healing begins. The rationale is straightforward: surgery creates the structural repair, and BMAC gives that repair the best possible biological conditions to heal and integrate.
Dr. Mirzayan's BMAC harvesting technique for proximal humerus bone marrow aspiration is featured on the Arthrex website — the world's leading arthroscopic surgery company — whose educational resources are used by orthopedic surgeons in over 100 countries. View the technique here: Proximal Humerus Bone Marrow Aspiration
Dr. Mirzayan uses BMAC surgically in the following procedures:
- Rotator cuff repair — Two peer-reviewed studies have demonstrated that BMAC applied at the time of rotator cuff repair significantly reduces the retear rate. Hernigou et al. (2014) and Cole et al. (2023) both showed meaningful improvement in healing outcomes when BMAC was used at the repair site. For a condition where retear rates can be substantial — particularly in large or massive tears — this is a clinically meaningful advantage.
- ACL reconstruction — Applied to the graft and tunnel sites to accelerate ligament integration and biological incorporation
- Meniscus repair — To enhance healing at the repair site, particularly in the relatively avascular inner zone of the meniscus where healing is naturally limited
When BMAC is used surgically, it is prepared at the time of the operation and applied directly — no additional procedure or recovery is required beyond the surgery itself.
The Harvest: Where Does the Bone Marrow Come From?
Dr. Mirzayan harvests bone marrow most commonly from the anterior or posterior superior iliac crest — the back or front of the pelvis, which is the richest and most accessible source of bone marrow in the body. Depending on the clinical situation, he has also harvested from the proximal humerus (upper arm bone) and the proximal femur (thigh bone).
The harvest is performed by placing a very small incision (about 5 mm or 1/5 inch) and with a specialized needle. Patients have minimal to no complain or problems from this site following this procedure.
Setting and Anesthesia
Some patients are able to tolerate the bone marrow harvest in the office under local anesthesia with just numbing medicine. However, most patients prefer — and Dr. Mirzayan recommends for comfort — having the procedure performed at a surgery center under sedation or anesthesia. This is especially true when BMAC is being used in conjunction with a surgical procedure, in which case everything is performed at the same time under the same anesthetic.
BMAC is an outpatient procedure. Patients go home the same day.
To discuss which setting is right for you, call (310) 746-5918).
How to Prepare for Your BMAC Treatment
The quality of your BMAC concentrate depends in part on how well you prepare your body before the harvest. Dr. Mirzayan recommends the following:
- Eat well in the days before your procedure. A nutritious diet supports optimal bone marrow health and cell yield.
- Stay well hydrated. Arrive well hydrated on the day of your procedure.
- Avoid alcohol and tobacco for at least several days beforehand, as both impair the quality of the biologic product.
- Stop all NSAIDs (ibuprofen, naproxen, aspirin, and similar medications) for at least one week before your procedure. Anti-inflammatory medications interfere with the activity of the regenerative cells in your bone marrow and can reduce the effectiveness of your treatment.
- Inform Dr. Mirzayan's team of all medications and supplements you are currently taking so that anything that might affect the procedure can be appropriately managed.
After Your BMAC Treatment
Following a standalone BMAC injection, some patients experience some mild soreness at both the harvest site and the injection site for a few days. This is a normal part of the biologic response and typically resolves within one to two weeks.
- Avoid strenuous activity for a few days following the procedure
- Continue to avoid NSAIDs after the injection — these medications can blunt the biologic response and should be avoided for at least two weeks
- Ice and acetaminophen can be used for comfort at the harvest site
- A follow-up appointment will be scheduled to monitor your response and progress
Most patients begin to notice improvement over four to eight weeks, as the biological healing process takes time to manifest clinically. Full benefit may take three to six months.
Is BMAC Covered by Insurance?
BMAC is not covered by insurance, including Medicare and Medicaid. It is a cash-pay procedure both as a standalone treatment and when used as a surgical adjunct.
For many patients, the cost of BMAC — particularly when used at the time of surgery to protect a rotator cuff repair or ACL reconstruction — is a worthwhile investment in the durability of their surgical outcome. A re-tear or graft failure means a second surgery. BMAC is an opportunity to give your first surgery the best possible chance of lasting.
Call (310) 746-5918 to learn more about BMAC pricing and scheduling.
Frequently Asked Questions
How is BMAC different from PRP?
Both are biologic treatments derived from your own body, but they are different products with different mechanisms. PRP is derived from your blood obtained from a vein at your elbow and is rich in platelets and growth factors. BMAC is derived from your bone marrow and is a combination of PRP and a broader population of regenerative cells and growth factors. In layman's terms, BMAC is a turbo-charged PRP.
Is the harvest painful?
The iliac crest harvest involves a needle puncture into the bone, which some patients find uncomfortable under local anesthesia alone. For this reason, most patients choose to have the procedure done at a surgery center under sedation. Dr. Mirzayan will discuss both options with you so you can choose what is right for you.
How long does the procedure take?
The full procedure — harvest, processing, and injection or surgical application — typically takes approximately one to two hours depending on the clinical setting.
How many treatments will I need?
For standalone injection, many patients respond to a single treatment. Some conditions may benefit from a repeat injection several months later. Dr. Mirzayan will discuss realistic expectations with you based on your specific diagnosis and imaging.
Does BMAC work for bone-on-bone arthritis?
BMAC is most effective in earlier to moderate stages of arthritis where some cartilage remains and biological stimulation can make a meaningful difference. For end-stage bone-on-bone arthritis, Dr. Mirzayan will be honest with you about whether BMAC is likely to provide meaningful benefit or whether a different treatment approach is more appropriate.
Is there any risk of rejection or infection?
Because BMAC is derived entirely from your own body, there is no risk of rejection. As with any procedure involving a needle, there is a small risk of infection, which is minimized through strict sterile technique. Dr. Mirzayan will review all risks with you in detail before proceeding.
Dr. Raffy Mirzayan is a double-board certified orthopedic sports medicine surgeon at DOCS Health, 8436 W 3rd St #800, Los Angeles, CA 90048. To schedule a BMAC consultation, call (310) 746-5918 or visit raffymirzayan.com.
