BACKGROUND: Bone marrow concentrate injections, orthobiologic treatments utilized for musculoskeletal diseases, are increasingly used by interventional pain management physicians, sports medicine physicians, and other musculoskeletal specialists. A rarely discussed yet clinically important is the “dry tap,” in which no marrow is obtained during aspiration. Although well-documented in the hematology-oncology literature, its significance and management in otherwise healthy patients remain unclear.

CASE REPORT: We present the case of a dry tap occurring during the in-office bone marrow aspiration of a patient with knee osteoarthritis who had no hematologic or oncologic history. This case prompted a multidisciplinary evaluation and highlighted the clinical uncertainty this issue presents for interventional pain management.

CONCLUSIONS: We reviewed the relevant literature. We propose a practical management algorithm developed in collaboration with hematology-oncology and sports medicine specialists. This approach may assist physicians to effectively deal with a dry tap during an orthobiologic procedure.

KEYWORDS: Dry tap, bone marrow aspiration, case report, orthobiologics, orthopedics, osteoarthritis