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Local Intraoperative Marrow-Derived Augmentation for Primary Rotator Cuff Repair: An Updated Systematic Review and
Stephen Le Breton1,2, Julianne Forlizzi1, Olivia Bono1,3
1New England Baptist Hospital, Boston, Massachusetts, USA.
Orthopaedic Journal of Sports Medicine
|April 3, 2023
Summary
Marrow stimulation techniques significantly reduce rotator cuff retear rates and improve healing compared to controls. Vented anchors show minimal benefit, suggesting marrow stimulation is a cost-effective option for preventing retears.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Regenerative Medicine
Background:
- Recurrent rotator cuff tears are a significant clinical challenge.
- Biologic augmentation aims to enhance rotator cuff repair outcomes.
- Marrow stimulation and vented anchors are intraoperative augmentation techniques.
Purpose of the Study:
- To systematically review and meta-analyze local, intraoperative marrow-derived augmentation techniques.
- To evaluate the efficacy of marrow stimulation and vented anchors in primary rotator cuff repair.
Main Methods:
- Systematic review of PubMed, Embase, and Cochrane databases (2010-2022).
- Meta-analysis of comparative clinical studies on marrow stimulation and vented anchors.
- PRISMA guidelines followed; heterogeneity assessed using I-squared statistic.
Main Results:
- Marrow stimulation significantly reduced retear rates (OR 0.41, P=.0003) and improved Constant scores (MD 2.84, P=.002).
- Pooled retear rate for marrow stimulation was 15% versus 30% for controls.
- Vented anchors showed no significant difference in retear rates (22.5% vs 27.8% for controls).
Conclusions:
- Marrow stimulation techniques positively impact rotator cuff healing and retear rates.
- Vented anchors demonstrate a limited impact on outcomes compared to nonvented anchors.
- Marrow stimulation is a potentially cost-effective method to prevent rotator cuff retears in select patients.