STRONG RECOMMENDATION Five-high and two moderate quality studies demonstrated that marrow stimulation (MS) does not have an effect on patient-reported outcomes such as the constant score (Ruiz Iban, 2021; Shibata, 2023; Lapner, 2021(b); Lapner, 2023; Milano, 2013; Toro, 2022; Hong, 2024(a)). One low quality study (Taniguchi, 2015) did demonstrate a decrease in re-tear rates. A high-quality study by Milano (2013) 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 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.
- Hong, K. B., Lee, T. H., Park, H. K., Lee, J. H., Chung, S. W., Park, J. Y. The Impact of Bone Marrow Stimulation on Arthroscopic Rotator Cuff Repair for Small to Large Rotator Cuff Tears: A Randomized Controlled Trial. Journal of Shoulder & Elbow Surgery 2024; 0: 13
- Lapner, P., Bouliane, M., Pollock, J. W., Coupal, S., Sabri, E., Hodgdon, T., Old, J., McIlquham, K., MacDonald, P., Stranges, G., Berdusco, R., Marsh, J., Dubberley, J., McRae, S. Intraoperative Channeling in Arthroscopic Rotator Cuff Repair: A Multicenter Randomized Controlled Trial. American Journal of Sports Medicine 2023; 2: 323-330
- Lapner, P., Pollock, J. W., Laneuville, O., Uhthoff, H. K., Zhang, T., Sheikh, A., McIlquham, K., Trudel, G. Preoperative bone marrow stimulation does not improve functional outcomes in arthroscopic cuff repair: a prospective randomized controlled trial. Bone & Joint Journal 2021; 1: 123-130
- Milano, G., Saccomanno, M. F., Careri, S., Taccardo, G., De Vitis, R., Fabbriciani, C. Efficacy of marrow-stimulating technique in arthroscopic rotator cuff repair: a prospective randomized study. Arthroscopy 2013; 5: 802-10
- Ruiz Iban, M. A., Sanchez Alepuz, E., Diaz Heredia, J., Hachem, A. I., Ezagui Bentolila, L., Calvo, A., Verdu, C., de Rus Aznar, I., Soler Romagosa, F. Footprint preparation with nanofractures in a supraspinatus repair cuts in half the retear rate at 1-year follow-up. A randomized controlled trial. Knee Surgery, Sports Traumatology, Arthroscopy 2021; 7: 2249-2256
- Shibata, T., Izaki, T., Miyake, S., Shibata, Y., Yamamoto, T. Efficacy of bone marrow stimulation for arthroscopic knotless suture bridge rotator cuff repair: a prospective randomized controlled trial. Journal of Shoulder & Elbow Surgery 2023; 5: 909-916
- Taniguchi, N., Suenaga, N., Oizumi, N., Miyoshi, N., Yamaguchi, H., Inoue, K., Chosa, E. Bone marrow stimulation at the footprint of arthroscopic surface-holding repair advances cuff repair integrity. Journal of Shoulder & Elbow Surgery 2015; 6: 860-6
- Toro, F., Pinochet, F., Ruiz, F., Moraga, C., Pozo, R., Oliva, J. P., Reinares, F., Mardones, P. Functional and radiologic results of the crimson duvet procedure in rotator cuff treatment: a randomized controlled clinical trial. Journal of Shoulder & Elbow Surgery 2022; 6: 1200-1207