The Role of Bone Marrow Stimulation Site in Arthroscopic Rotator Cuff Repair: A Prospective Randomized Controlled Study on a New “Greenhouse” Technique Compared With the Traditional “Crimson Duvet” Technique

Background: Although bone marrow stimulation (BMS) is believed to promote rotator cuff healing, there is no comparison of clinical outcomes and structural integrity between different BMS techniques in patients undergoing arthroscopic rotator cuff repair (ARCR). Purpose/Hypothesis: The purpose of this study was to compare the clinical outcomes and structural integrity between BMS inside the rotator cuff footprint area (“greenhouse” technique) and BMS outside the rotator cuff footprint area (“crimson duvet” technique). It was hypothesized that the new “greenhouse” technique would provide better clinical outcomes and structural integrity at short-term follow-up. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: This study included 60 patients who underwent ARCR using the “greenhouse” technique or “crimson duvet” technique (n = 30 per group). Functional outcomes at 24 months postoperatively were assessed including the ASES (American Shoulder and Elbow Surgeons) score, CMS (Constant-Murley score), UCLA (University of California, Los Angeles) score, SST (Simple Shoulder Test), VAS (visual analog scale) for pain, and range of motion consisting of forward elevation, external rotation, and internal rotation. The minimal clinically important difference, patient acceptable symptom state, substantial clinical benefit, and maximum outcome improvement were also compared between the 2 groups. Structural integrity was evaluated by magnetic resonance imaging at 2 years postoperatively and compared between the 2 groups. Results: All functional outcomes improved significantly compared with preoperatively in both groups at the last follow-up (all P < .001). However, there were no significant differences between the 2 groups postoperatively. Overall, 52 patients (86.7%) achieved the minimal clinically important difference, 44 patients (73.3%) achieved the patient acceptable symptom state, 45 patients (75.0%) achieved the substantial clinical benefit, and 31 patients (51.7%) achieved the maximum outcome improvement, without significant differences between the 2 groups. The retear rate after ARCR in the “greenhouse” group was 6.7% and 10.0% in the “crimson duvet” group, which was not significantly different. Conclusion: In ARCR, both the “greenhouse” and “crimson duvet” techniques exhibited significant functional improvement in patients with rotator cuff tears. The new “greenhouse” technique provided comparable clinical outcomes and structural integrity compared with the traditional “crimson duvet” technique at short-term follow-up. Registration: NCT04686968 (ClinicalTrials.gov)