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Review
. 2024 Aug 23;16(8):e67594.
doi: 10.7759/cureus.67594. eCollection 2024 Aug.

A Comparison of Functional Outcomes in Rotator Cuff Repairs Using Adjunctive Bone Marrow Aspirate Concentrate vs. Bone Marrow Aspirate Concentrate With Platelet-Rich Plasma: A Systematic Review and Meta-Analysis

Seth J Spicer  1   2 , Sara Soliman  3   2 , Robert Malek  4   2 , Mitchell Kaplan  5   2 , Jensen Clark  5 , Nicholas Averell  5   2 , Brandon Goodwin  6   2 , Richard Jermyn  7
Affiliations
Review

A Comparison of Functional Outcomes in Rotator Cuff Repairs Using Adjunctive Bone Marrow Aspirate Concentrate vs. Bone Marrow Aspirate Concentrate With Platelet-Rich Plasma: A Systematic Review and Meta-Analysis

Seth J Spicer et al. Cureus. .

Abstract

Regenerative medicine, specifically bone marrow aspirate concentrate (BMAC) and platelet-rich plasma (PRP), has become a novel adjunct that orthopedic surgeons have started to use with surgical rotator cuff repairs (RCR). Thus, we are conducting this systematic review to determine if either RCRs with BMAC alone or with BMAC and PRP result in superior functional outcomes. We conducted a comprehensive search using five databases including PubMed, Web of Science, Embase, Scopus, and Cochrane. After duplicates were removed, 1205 studies were screened by title and abstract using Rayyan, resulting in three included studies (one BMAC with PRP and two BMAC only). Only studies that reported functional outcomes using the American Shoulder and Elbow Surgeons Shoulder Score and the University of California Los Angeles Shoulder Score were included. Changes in assessment scores from baseline to follow-up evaluation were quantified using the effect size and used in the meta-analysis for each group. Interpretation of treatment efficacy was represented using Cohen's d. The effect size of BMAC with PRP (Cohen's d = 2.19) was not significantly different (p = 0.76) from that of BMAC alone (Cohen's d = 2.35). Between-group differences in functional outcomes were Cohen's d = 0.16, which was not significant. Given the lack of superiority and the small sample size, more research is required before a conclusion can be drawn as to the benefits of combining PRP with BMAC for RCR. If functional outcomes are the same, using BMAC alone as an adjunct may be optimal to reduce resources used and cost. Future studies should be conducted with a larger pool as our primary limitation is that only three studies were included.

Keywords: bone marrow aspirate concentrate; orthopedic surgery; platelet rich plasma; regenerative medicine; rotator cuff repair; shoulder arthroscopy; stem cell therapy.

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Conflict of interest statement

Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Article selection flow sheet per PRISMA 2020 guidelines; certainty of evidence and risk of bias assessment.
*The five databases searched were PubMed, Web of Science, Scopus, Embase, and Cochrane. **Studies were screened independently via title and abstract by two reviewers against the inclusion and exclusion criteria. Included were studies of any language, publication time, or design, that consisted of primary clinical outcome data on the use of BMAC augmentation for rotator cuff repair and BMAC with PRP for rotator cuff repair. Articles were not excluded based on the date of publication, language of publication, or nation of origin. Excluded were articles without full text available, studies still in progress without any reported data, animal studies, those that did not include a bone marrow aspirate concentrate group, and those that included additional augmentations other than BMAC. BMAC: Bone marrow aspirate concentrate.
Figure 2
Figure 2. Bias assessment using the ROBINS-I tool.
Green = Low risk of bias, Yellow = Moderate risk of bias, Red = High risk of bias.
Figure 3
Figure 3. Forest plot of the random-effects model meta-analysis comparing the combination of PRP and BMAC versus BMAC alone in the augmentation of arthroscopic rotator cuff repair.
Subgroup 1 is BMAC alone; subgroup 2 is BMAC with PRP. Subgroup and overall effect sizes are provided. BMAC: Bone marrow aspirate concentrate; PRP: Platelet-rich plasma.
See this image and copyright information in PMC

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