Bone Marrow Stimulation Yielded Similar Clinical Outcomes With Improved Tendon Healing and Abduction Strength Compared With Decortication for Arthroscopic Rotator Cuff Repair in Shoulder Active Patients

PURPOSE: To compare the clinical outcomes and tendon healing between bone marrow stimulation (BMS) and decortication as footprint preparation techniques for arthroscopic rotator cuff repair (ARCR) in shoulder active patients. METHODS: This double-blinded randomized clinical trial recruited 120 patients aged older than 45 years, at active levels, and diagnosed with chronic unilateral rotator cuff tears. Participants were 1:1 randomized to undergo ARCR using the double-row suture-bridge technique with BMS (BMS group) or with decortication (DEC group) for footprint preparation. The primary outcome was the American Shoulder and Elbow Surgeons score (range, 0-100, with greater scores indicating better shoulder function and fewer symptoms) at 24 months. Secondary outcomes included patient-reported outcomes, physical examinations, and rotator cuff integrity (evaluated on magnetic resonance imaging using a 5-graded system). RESULTS: Of the 120 participants (age, 58.7 ± 8.1 years; 83 females [69.2%]) enrolled and randomized between May 2017 and November 2021, 109 (90.8%) were analyzed with the completion of follow-up visits. The American Shoulder and Elbow Surgeons scores at 24 months were not statistically significantly different between the BMS and DEC groups (89.2 ± 12.2 vs 87.8 ± 13.9; adjusted difference, 1.7; 95% confidence interval -3.3 to 6.7; P = .498). The BMS group showed superior rotator cuff integrity (incomplete healing, 33.9% vs 54.7%; P = .029) and abduction muscle strength (8.7 ± 3.2 vs 7.4 ± 3.3 kg; P = .031) at 24 months as compared with the DEC group; the superiority was more significant in the subgroup of participants with higher shoulder activity levels. The rates of adverse events were comparable between groups. CONCLUSIONS: Among shoulder active patients undergoing ARCR, BMS did not result in superior patient-reported outcomes at 24 months postoperatively compared with decortication. Nevertheless, BMS resulted in greater rates of tendon healing and clinically significant improvement in abduction strength and thus can be recommended in patients requiring high levels of manual labor or sports activities. LEVEL OF EVIDENCE: Level I, randomized clinical trial.