Bone marrow stimulation in arthroscopic rotator cuff repair: a meta-analysis

Arthroscopic rotator cuff repair (ARCR) is a common and successful operation; however, re-ruptures are relatively common. The association of Bone marrow stimulation (BMS) has been proposed to increase outcomes and reduce re-tear rates. The study aims to compare the effect of concomitant BMS and ARCR with isolated rotator cuff repair (RCR). The PubMed, MEDLINE, Scopus, and Cochrane Central databases were used to search for keywords, and a total of 15 studies were included. The primary outcomes were retear rates. The data extracted for quantitative analysis include the American Shoulder and Elbow Surgeons (ASES), Constant-Murley score (CMS), University of California, Los Angeles (UCLA) scores, simple shoulder test (SST), visual analogue scale (VAS), and range of motion. A total of 2193 relevant articles were identified, and 15 comparative studies were eligible for the meta-analysis. A total of 1552 patients were identified, of whom 776 and 776 underwent ARCR with BMS stimulation and isolated ARCR, respectively. At FU, a significantly higher retear rate was observed in the isolated ARCR group (14% vs 18%, OR = 0.69, 95% CI [0.51, 0.92], P = 0.01). When only patients with double-row were considered, no significant difference was found between the groups (11% vs 16%, OR = 0.66, 95% CI [0.42,1.04], P = 0.07); however, when only patients with single-row were analyzed, an even more significantly higher retear rate was found in the isolated ARCR group (16% vs 27%, OR = 0.42,95% CI [0.26, 0.66], P = 0.0002). A statistically significant difference was found in favor of the ARCR with the BMS group in terms of elevation, while no difference was found in terms of external and internal rotation. This meta-analysis showed significantly lower retear rate in the ARCR with BMS group, especially for those patients who received single row repair, with significantly superior outcomes in terms of ASES, CMS, and elevation at last FU. No statistically significant difference was observed in retear rate in patients who received double-row repair, in terms of SST, UCLA score, VAS, external and internal rotation at last FU. III.