Marrow Stimulation
Limited evidence suggests that marrow stimulation at the time of rotator cuff repair does not improve patient-reported outcomes; however, this technique may decrease re-tear rates in patients with larger tear sizes.
Management of Rotator Cuff Injuries
Endorsed by: AANA, ASES, AOSSM, ASSET, APTA

Rationale
Three low to high quality studies (Milano G. 2010, Osti, L. 2010, Taniguchi, N. 2015) demonstrated that marrow stimulation (MS) does not have an effect on patient reported outcomes such as the constant score.  One low quality study (Taniguchi) did demonstrate a decrease in re-tear rates. A high quality study by Milano demonstrated decreased re-tear rates in larger tears.

Risks and Harms of Implementing this Recommendation
The risk of complications with MS is low.  If several microfracture holes are made in the footprint that are too close together there is the theoretical potential of comprising the fixation strength of suture anchors.

Future Research
Future studies should be large enough such that the statistical analyses will allow for consideration of confounders such as fixation constructs, size of tears, etc.. Consistency in the definition of a rotator cuff re-tear is also encouraged.

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