2023 ISAKOS Biennial Congress ePoster
Marrow-Derived Augmentation for Primary Rotator Cuff Repair: Systematic Review and Meta-Analysis
Stephen Le Breton, BS, Boston UNITED STATES
Julaine Forlizzi , MD, Boston UNITED STATES
Olivia Bono, BS, Boston UNITED STATES
Albert Mousad, BS, Boston, MA UNITED STATES
Sophie Kush , BS, Boston UNITED STATES
Alaia Christensen, BS, MD, Dunn Loring, Virginia UNITED STATES
Arun Ramappa, MD, West Newton, MA UNITED STATES
Glen Ross, MD, Boston, MA UNITED STATES
Sarav Shah, MD, Boston, MA UNITED STATES
New England Baptist Hospital , Boston, Massachusetts, UNITED STATES
FDA Status Not Applicable
Summary
Current evidence demonstrates that marrow stimulation techniques may have a positive impact on healing and retear rate, while vented anchors have muted impact relative to non-vented anchors.
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Abstract
Purpose
Recurrent tears pose a substantial problem despite advances in surgical technique. Biologic augmentation via marrow stimulation or vented anchors may strengthen the suture-tendon junction and improve healing rates of native tissue, thereby enhancing outcomes of primary surgical repair.
Our purpose is to provide a focused systematic review and meta-analysis of local, procedural marrow-derived augmentation techniques in preclinical and clinical primary rotator cuff repair.
Methods
A systematic review was conducted following PRISMA guidelines. Relevant paper selection was conducted by two independent reviewers. Studies from 2010-2022, focused on either marrow stimulation or vented anchors, were classified as either preclinical or clinical. Meta-analyses were performed for comparative marrow stimulation and vented anchor studies.
Results
Seventeen studies (13 clinical; 4 preclinical) were included in the study. The pooled retear rate across all 9 clinical marrow stimulation studies was 11%. For the 5 studies in the meta-analysis, the pooled retear rates were 15% for marrow stimulation and 30% for controls. Meta-analysis demonstrated marrow stimulation reduced the overall retear rate (OR 0.40; 95% CI, 0.25-0.66; P=0.0003, I2=0%) and improved Constant Score (Mean diff. 2.84; 95% CI, 1.02-4.66; P=0.002, I2=29%) relative to controls. Clinical vented anchor studies demonstrated improved ossification and bone density at the anchor site, but no difference in outcomes or retear (22.5% for vented anchor vs. 27.8% for control). Preclinically, marrow stimulation and vented anchors are promising both histologically and mechanically, demonstrating improved histologic parameters and greater mean load-to-failure.
Conclusion
Current evidence demonstrates that marrow stimulation techniques may have a positive impact on healing and retear rate, while vented anchors have muted impact relative to non-vented anchors. Though available evidence is limited and more research is needed, findings to date suggest marrow stimulation techniques may be an inexpensive, straightforward technique to consider in qualifying patients to prevent rotator cuff retears.