Preoperative bone marrow stimulation does not improve functional outcomes in arthroscopic cuff repair: a prospective randomized controlled trial

Bone Joint J. 2021 Jan;103-B(1):123-130. doi: 10.1302/0301-620X.103B1.BJJ-2020-0011.R2.

Abstract

Aims: Despite recent advances in arthroscopic rotator cuff repair, re-tear rates remain high. New methods to improve healing rates following rotator cuff repair must be sought. Our primary objective was to determine if adjunctive bone marrow stimulation with channelling five to seven days prior to arthroscopic cuff repair would lead to higher Western Ontario Rotator Cuff (WORC) scores at 24 months postoperatively compared with no channelling.

Methods: A prospective, randomized controlled trial was conducted in patients undergoing arthroscopic rotator cuff repair. Patients were randomized to receive either a percutaneous bone channelling of the rotator cuff footprint or a sham procedure under ultrasound guidance five to seven days prior to index surgery. Outcome measures included the WORC, American Shoulder and Elbow Surgeons (ASES), and Constant scores, strength, ultrasound-determined healing rates, and adverse events.

Results: Overall, 94 patients were randomized to either bone channelling or a sham procedure. Statistically significant improvements in all clinical outcome scores occurred in both groups from preoperative to all timepoints (p < 0.001). Intention-to-treat analysis revealed no statistical differences in WORC scores between the two interventions at 24 months postoperatively (p = 0.690). No differences were observed in secondary outcomes at any timepoint and healing rates did not differ between groups (p = 0.186).

Conclusion: Preoperative bone channelling one week prior to arthroscopic rotator cuff repair was not associated with significant improvements in WORC, ASES, Constant scores, strength, or ultrasound-determined healing rates. Cite this article: Bone Joint J 2021;103-B(1):123-130.

Keywords: Bone stimulation; Channeling; Mesenchymal stem cell; Microfracture; Rotator cuff; Shoulder joint; Tendon; Tendon healing; Trephination.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Arthroscopy*
  • Bone Marrow / surgery*
  • Double-Blind Method
  • Female
  • Humans
  • Male
  • Middle Aged
  • Preoperative Period
  • Prospective Studies
  • Rotator Cuff Injuries / surgery*
  • Ultrasonography, Interventional