Study: Bone marrow stimulation provided no benefit to arthroscopic rotator cuff repair
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Key takeaways:
- Patients undergoing arthroscopic rotator cuff repair may not benefit from bone marrow stimulation.
- Patients who received bone marrow stimulation had comparable outcomes to patients who did not.
Published results showed arthroscopic rotator cuff repair with bone marrow stimulation yielded no significant improvements in retear rate, functional outcomes or complications compared with arthroscopic rotator cuff repair alone.
Researchers used the PubMed, EMBASE, Cochrane Library and Web of Science databases to perform a systematic review and meta-analysis of seven randomized controlled trials with 638 patients who underwent arthroscopic rotator cuff repair. According to the study, 316 patients underwent arthroscopic rotator cuff repair with bone marrow stimulation (BMS) and 322 patients underwent arthroscopic rotator cuff repair alone.
In all trials, researchers found BMS cohorts and control cohorts had comparable retear rates (odds ratio = 0.87), Constant-Murley scores (weighted mean difference [WMD] = 1.39), American Shoulder and Elbow Surgeons scores (WMD = 0.63), Western Ontario Rotator Cuff Index scores (WMD = –3.11), VAS pain scores (WMD = 0.27), forward flexion (WMD = 2.41), external rotation (WMD = 0.80), severe complication rates (OR = 1.39) and mild complication rates (OR = 1.96).
“This finding suggests that patients with rotator cuff tears may not benefit from BMS, despite BMS being a simple and cost-effective procedure,” the researchers wrote in the study.
Perspective
Back to TopDavid Kovacevic, MD, FAAOS, and Karina Marin, PA-C
For our patients with symptomatic rotator cuff injuries requiring surgical repair, there is an ongoing need for augmentation in situations with poor tissue quality, an unfavorable biologic environment and unmodifiable patient factors. Current BMS techniques are one augmentation strategy that do not lead to lower retear rates, improved patient-reported outcome measures (PROM) performance or greater functional capacity.
A recently published meta-analysis by Long Pang, MD, and colleagues suggests that arthroscopic rotator cuff repair (RCR) plus BMS techniques, such as microfracture, nanofracture, trephination or bone marrow channeling, compared to arthroscopic RCR alone do not decrease retear rates (arthroscopic RCR, 18.5% vs. arthroscopic RCR plus BMS, 20.6%), improve PROM performance, lead to lower VAS pain scores, greater range of motion or lower total complication profile (arthroscopic RCR, 2.7% vs. arthroscopic RCR plus BMS, 5.4%). These findings have been independently corroborated by Jillian A. Fairley, MD, FRCSC, MASc, and colleagues.
Comparable to the poor long-term outcomes with first-generation BMS techniques in the knee, contemporary BMS techniques such as deep drilling, we posit will prove more successful when utilized with a bioinductive, porous collagen bilayer interposition scaffold. Deep drilling will allow for greater depth of perforation, absence of trabecular bone compaction and enhanced access to autologous bone marrow stroma, while the interposition scaffold will provide the microarchitecture to recapitulate a more native tendon-bone insertion site. Continued deep investment in such porous interposition scaffolds will be needed to separate the wheat from the chaff.
References:
Dandu N, et al. Arthrosc Tech. 2022;doi:10.1016/j.eats.2021.11.021.
Fairley JA, et al. J Shoulder Elbow Surg. 2023;doi:10.1016/j.jse.2023.08.012.
Kraeutler MJ, et al. Orthop J Sports Med. 2020;doi:10.1177/2325967120945313.
Pang L, et al. Arthroscopy. 2023;doi:10.1016/j.arthro.2023.10.025.
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