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Marrow-Derived Augmentation for Primary Rotator Cuff Repair: Systematic Review and Meta-Analysis

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Marrow-Derived Augmentation for Primary Rotator Cuff Repair: Systematic Review and Meta-Analysis

Stephen Le Breton, BS, UNITED STATES Julaine Forlizzi , MD, UNITED STATES Olivia Bono, BS, UNITED STATES Albert Mousad, BS, UNITED STATES Sophie Kush , BS, UNITED STATES Alaia Christensen, BS, MD, UNITED STATES Arun Ramappa, MD, UNITED STATES Glen Ross, MD, UNITED STATES Sarav Shah, MD, UNITED STATES

New England Baptist Hospital , Boston, Massachusetts, UNITED STATES

2023 Congress ePoster Presentation 2023 Congress Not yet rated

Anatomic Location

Shoulder Rotator Cuff

Diagnosis / Condition

Tears

Treatment / Technique

Arthroscopy

Sports Medicine

Biomechanics

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.

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.

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Marrow-Derived Augmentation for Primary Rotator Cuff Repair: Systematic Review and Meta-Analysis

Marrow-Derived Augmentation for Primary Rotator Cuff Repair: Systematic Review and Meta-Analysis

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Marrow-Derived Augmentation for Primary Rotator Cuff Repair: Systematic Review and Meta-Analysis

Marrow-Derived Augmentation for Primary Rotator Cuff Repair: Systematic Review and Meta-Analysis

Purpose

Methods

Results

Conclusion

More 2023 ISAKOS Congress Content