Purpose: To review the current literature regarding the use of bone marrow aspirate concentrate (BMAC) in rotator cuff repair surgery to determine variations in the preparation and administration of BMAC; assess the healing rates with the use of BMAC in terms of postoperative range of motion (ROM), patient-reported outcomes (PROMs), and retear rates; and analyze the safety of using BMAC.
Methods: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses compliant search was performed. Two independent authors screened all suitable studies for their inclusion, obtained the data, and assessed risk of bias. The types of studies included in the analysis were human studies of randomized control trials, prospective cohort, case control, and case series.
Results: Seven studies reported PROMs: 4 of 7 studies reported statistically significant improvements in at least 4 different scores, with 2 of 7 studies reporting general improvements in the BMAC groups (with no statistical analysis provided). Of the 2 comparative studies, neither was able to show a difference in PROMs between the control and biologic groups. Postoperative ROM was reported in 5 studies: 3 of 5 studies showed statistically significant improvement in ROM, 1 study showed general improvement (with no statistical analysis provided), and 1 study showed no difference in postoperative ROM between a BMAC and control group. Retear rates were mixed: 1 study reported that rates between the concentrated bone marrow aspirate and control group did not differ (P = .964), while another found that the mesenchymal stem cell augmentation improved healing both short term (6 months) and long-term (10 years). There were no complications associated with the use of BMAC in rotator cuff repairs in any of the studies included.
Conclusions: This systematic review shows that BMAC as an intervention in rotator cuff repair has not been associated with increased complication rates. In the available literature, there is significant heterogeneity among the included studies in terms of study design, patient demographics, surgical techniques, and methods of BMAC preparation and application as well as reported measures and follow-up periods. Some studies suggest that BMAC may enhance healing rates, pain relief, and functional improvements for both short- and long-term outcomes.
Level of evidence: Level IV, systematic review of Level I to IV studies.
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