Bone marrow stimulation in arthroscopic rotator cuff repair: a meta-analysis
Journal of Orthopaedic Surgery and Research · 22 Aug 2026
† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.
Why it matters
Retear after rotator cuff repair remains common, and this synthesis suggests a cheap, autologous biologic augmentation (marrow venting) may reduce retear risk, particularly when using single-row fixation, which is clinically relevant for surgeons deciding whether to add BMS during ARCR.
The evidence
This meta-analysis pooled 15 comparative studies (1552 patients) comparing arthroscopic rotator cuff repair (ARCR) with versus without bone marrow stimulation (BMS, e.g. microfracture or marrow venting of the greater tuberosity). Overall, adding BMS was associated with a lower retear rate (14% vs 18%, OR 0.69, 95% CI 0.51-0.92, p=0.01), an effect driven mainly by single-row repairs (16% vs 27%, p=0.0002), while the double-row subgroup showed a similar trend that was not statistically significant (11% vs 16%, p=0.07). Postoperative ASES and Constant-Murley scores and forward elevation were modestly better with BMS, but simple shoulder test, UCLA score, VAS pain, and rotation were unchanged between groups.
retear rate: Odds ratio 0.69 (95% CI 0.51 to 0.92; units not reported). The interval favours the first group; the size of the benefit needs clinical interpretation.
Why this rigour score?
Meta-analysis (mixed designs)Design starting point: 42.6
Raised the score
- Compared against current standard of care+3.4
- Comprehensive literature search+3.4
Lowered the score
- No assessment of publication bias across 15 studies−6.8
- Pools mixed study designs−3.4
Score capped at 42. Two or more critical methodological failures for a review.
Methods at a glance
Recorded assessment- Comprehensive literature searchMet
- Risk of bias assessedMet
- Bias considered in synthesisNot met
- Publication bias assessedNot met
- Study exclusions justifiedNot met
- Prospective registrationNot reported
Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.
See the full score breakdown
- Study design starting point
- 42.6
- Compared against current standard of care
- +3.4
- Pools mixed study designs
- −3.4
- Comprehensive literature search
- +3.4
- Risk of bias assessed in the included studies
- +3.4
- No assessment of publication bias across 15 studies
- −6.8
- Journal prior (not an observed method)
- +0.6
- Methodological cap
- −1.2
- Final rigour score rounded
- 42 / 100
Study design sets the starting point and a ceiling of 82. Recorded methods then adjust the score. Points are shown to one decimal place; the final score uses unrounded values.
Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.
For journal club
1.Should surgeons preferentially add bone marrow stimulation when performing single-row rather than double-row rotator cuff repairs, given the differential retear benefit seen here?
2.Given the marginal functional score differences (ASES +1.6, CMS +2.5 points) versus reported MCIDs, should BMS be adopted primarily to reduce retear risk rather than to improve patient-reported function?
Original publication title
Bone marrow stimulation in arthroscopic rotator cuff repair: a meta-analysis