The role of bone marrow stimulation in rotator cuff repair: a systematic review and meta‐analysis

Abstract

Purpose The objective of this study was to investigate whether RCR (rotator cuff repair) with BMS (bone marrow stimulation) can provide a lower retear rate and better shoulder function than arthroscopic RCR alone in rotator cuff tear (RCT) patients. Method The PubMed, Cochrane Library, EMBASE and Web of Science databases were searched until Feb 2022. Risk of bias for randomized controlled trials was evaluated by two independent reviewers with Cochrane collaboration risk bias of tool, and that for cohort studies was evaluated with the Newcastle–Ottawa Scale (NOS). The primary outcome was the retear rate. Secondary outcomes included the American Shoulder and Elbow Surgeons (ASES) score, University of California, Los Angeles Shoulder Scale (UCLA) score, Constant-Murley score (CMS) and visual analogue scale (VAS) score. Subgroup analysis was performed to explore the effect of suture method and tear size on BMS procedure. Result Five randomized controlled trials and four cohort studies with a total of 827 patients were included. The pooled retear rate between the RCR with BMS group and the RCR alone group was significantly different (17.5% vs. 28.9%; P < 0.0001). There were no differences in the ASES score, UCLA score and VAS score. The CMS was significantly higher in RCR with BMS group than the RCR alone groups (P = 0.02), while the difference was well below the MCID. RCR with BMS resulted in a significantly lower retear rate than RCR alone for large and massive RCTs (19.7% vs. 32.5%; P = 0.01). Conclusion Compared with RCR alone, RCR with BMS can significantly reduce the retear rate in arthroscopic RCT patients while not clinically relevant differences were found. BMS may further reduce the retear rate of large and massive RCTs. Level of evidence Level III; Systematic Review and Meta-analysis.

Similar Healing Rates of Arthroscopic Rotator Cuff Repair With and Without Bone Marrow Stimulation: A Systematic Review and Meta-analysis of Randomized Controlled Trials

“…Previous systematic reviews 1,18,31,32 have found that although the clinical outcomes were similar, arthroscopic rotator cuff repair with BMS had a significantly higher healing rate than conventional rotator cuff repair. However, these systematic reviews included retrospective cohort studies, which have a low level of evidence and can have some biases and limitations.…”

“…Li and Zhang 18 included 4 randomized controlled trials and 4 retrospective cohort studies in their review. Yang et al 31 conducted a review that involved 5 randomized controlled trials and 4 cohort studies. Zhang et al 32 included 4 randomized controlled trials and 4 retrospective cohort studies in their review.…”

“…Clinical studies on the effect of BMS in enhancing healing rates and outcomes after rotator cuff restoration have shown variable results. 1,11,16,20,21,25,28,29 Several previous systematic reviews by Ajrawat et al, 1 Li and Zhang, 18 Yang et al, 31 and Zhang et al, 32 which included level 3 evidence studies, found that rotator cuff repair with BMS reduces the retear rate but shows no difference in postoperative patient-reported outcomes compared with repair without BMS. However, the systematic reviews included retrospective studies and might have selection biases.…”