Bone Marrow Stimulation Versus Decortication for Footprint Preparation in Arthroscopic Rotator Cuff Repair: A Randomized Clinical Trial

To compare the clinical and radiological outcomes between bone marrow stimulation (BMS) and decortication as footprint preparation techniques in patients undergoing arthroscopic rotator cuff repair (ARCR). This double-blinded randomized clinical trial recruited 120 patients aged over 45 years, at active levels, and diagnosed with chronic unilateral rotator cuff tears. Participants were 1:1 randomized to undergo ARCR using the double-row suture-bridge technique with BMS (BMS group) or with decortication (DEC group) for footprint preparation. The primary outcome was the American Shoulder and Elbow Surgeons (ASES) score (range, 0–100, with higher scores indicating better shoulder function and fewer symptoms) at 24 months. Secondary outcomes included patient-reported outcomes, physical examinations, and rotator cuff integrity (evaluated on magnetic resonance imaging using a 5-graded system). Of the 120 participants (age, 58.7 ± 8.1 years; 83 females [69.2%]) enrolled and randomized between May 2017 and November 2021, 109 (90.8%) were analyzed with the completion of follow-up visits. The ASES scores at 24 months were not statistically significantly different between the BMS and DEC groups (89.2 ± 12.2 vs. 87.8 ± 13.9; adjusted difference, 1.7 [95% CI, −3.3 to 6.7]; P = .498). The BMS group showed superior abduction muscle strength (8.7 ± 3.2 vs. 7.4 ± 3.3 kg; P = .031) and rotator cuff integrity (undesirable integrity, 33.9% vs. 54.7%; P = .029) at 24 months as compared with the DEC group; the superiority was more significant in the subgroup of participants with higher shoulder activity levels. The rates of adverse events were comparable between groups. Among patients undergoing ARCR, BMS did not result in superior patient-reported outcomes at 24 months postoperatively compared with decortication. Nevertheless, BMS was superior in improving abduction strength and rotator cuff integrity and may be preferred in patients requiring high levels of manual labor or sports activities.