Abstract / Summary
The effectiveness of intraoperative bone marrow stimulation (BMS) in improving outcomes following arthroscopic rotator cuff repair remains uncertain. This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to evaluate the impact of BMS on postoperative retear rates and clinical function. We searched multiple databases up to April 2025 for RCTs comparing arthroscopic repair with versus without intraoperative BMS for full-thickness tears, following the PRISMA 2020 guidelines. 8 RCTs involving 924 patients were included. The meta-analysis revealed no statistically significant differences between the BMS and control groups in the retear rate (RR = 0.86, 95% CI [0.57, 1.32], P = 0.50), forward flexion (MD = 2.09, 95% CI [-0.27, 4.44], P = 0.08), external rotation (MD = 1.21, 95% CI [-1.13, 3.55], P = 0.31), Constant score (MD = 1.01, 95% CI [-0.45, 2.48], P = 0.18), ASES score (MD = 1.44, 95% CI [-0.03, 2.91], P = 0.05), UCLA score (MD=-0.29, 95% CI [-1.69, 1.10], P = 0.68), or VAS (MD=-0.12, 95% CI [-0.36, 0.12], P = 0.32). Subgroup analysis identified the imaging modality (MRI vs. ultrasound) for retear assessment as a major source of heterogeneity ( I² =87.8%, P = 0.004). BMS showed lower retear rates in the ≤ 1-year follow-up subgroup (RR = 0.59, 95% CI [0.38, 0.91], P = 0.02), MRI-assessment subgroup (RR = 0.69, 95% CI [0.52, 0.93], P = 0.01) and using Sugaya III–V as the criterion for failure subgroup (RR = 0.66, 95% CI [0.46, 0.93], P = 0.02) ; however, these findings are derived from small, exploratory subgroups and were not sustained at longer follow-up. Intraoperative BMS does not confer a significant overall benefit in reducing retears or improving functional outcomes after arthroscopic rotator cuff repair. Apparent subgroup differences are highly dependent on methodological factors—particularly the choice of imaging modality—and should not be interpreted as definitive evidence of biological efficacy. Current evidence, graded as low certainty, does not support the routine use of BMS. Not applicable.