879 - Bone marrow aspirate concentrate augmentation in rotator cuff re-tear: A systematic review and meta-analysis.

Objectives: To investigate the potential benefits of bone marrow aspirate concentration (BMAC) on rotator cuff retear rates following adjunctive application during rotator cuff surgery.

Design: A systematic review and single-proportion meta analysis was conducted employing the PRISMA 2020 guidelines. This systematic review utilized five medical databases to search for articles on the use of bone marrow aspirate concentrate augmentation for rotator cuff repair and tear recurrence requiring revision. These databases include: PubMed, Embase, Scopus, WebOfScience, and Cochrane Library. Outcomes of interest included decreased rotator cuff tear recurrence and revision rates.

Results: A comprehensive review of the literature yielded a total of six included studies, encompassing a combined sample of 246 individuals. Among this group, 216 individuals demonstrated the absence of retear following BMAC intervention. Using the common effect model, the estimated proportion of individuals avoiding retear was 0.8852 (95% CI: 0.8388 to 0.9196), signifying approximately 88.52% of individuals achieved successful outcomes following BMAC treatment. Similarly, The random effect model yielded an estimated proportion of 0.8576 (95% CI: 0.6735 to 0.9462) suggesting that approximately 85.76% of individuals were avoided of re-tear.

Conclusions: Adjunctive BMAC injection is a novel treatment option that has become popular due to the growing orthobiologics field and the advancement of stem cell research. Because of its relative novelty, literature regarding this treatment option is limited, however, all the studies discussed in this systematic review report positive outcomes with the majority of patients reporting minimal incidence of retear. Several studies showed the superior efficacy of the BMAC injection compared to standard of care. However, since the studies in this systematic review used an array of outcome measures, a direct comparison of outcome measures cannot be completed due to the notable degree of variability in effect as described by the heterogeneity test.

Scientific Paper Best Paper Award Abstract: Objective

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  Adjunctive orthobiologics are starting to be integrated into all facets of medical practice. We sought to investigate the potential benefits of bone marrow aspirate concentration (BMAC) on rotator cuff retear rates following adjunctive application during rotator cuff surgery.
  
  

Methods

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  A systematic review and single-proportion meta analysis was conducted employing the PRISMA 2020 guidelines. This systematic review utilized five medical databases to search for articles on the use of bone marrow aspirate concentrate augmentation for rotator cuff repair and tear recurrence requiring revision. These databases include: PubMed, Embase, Scopus, WebOfScience, and Cochrane Library. Studies that consisted of primary clinical data on the use of bone marrow aspirate concentrate augmentation for rotator cuff repair and tear recurrence requiring revision were analyzed. Case-control series, cohort studies, prospective studies, retrospective review, and randomized control trials were included in the inclusion criterion. Outcomes of interest included decreased rotator cuff tear recurrence and revision rates. Article formats excluded from analysis: articles without full text available, studies still in progress without any reported data, or animal studies. Articles which did not include a bone marrow aspirate concentrate arm or included additional augmentations other than bone marrow aspirate concentrate in their study design were also excluded.
  
  

Results

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  A comprehensive review of the literature yielded a total of six included studies, encompassing a combined sample of 246 individuals. Among this group, 216 individuals demonstrated the absence of retear following BMAC intervention. Using the common effect model, the estimated proportion of individuals avoiding retear was 0.8852 (95% CI: 0.8388 to 0.9196), signifying approximately 88.52% of individuals achieved successful outcomes following BMAC treatment. Similarly, The random effect model yielded an estimated proportion of 0.8576 (95% CI: 0.6735 to 0.9462) suggesting that approximately 85.76% of individuals were avoided of retear. The Wald-type test, comparing the estimated effect size to its standard error to assess its significance, yielded statistically significant heterogeneity (Q = 23.39, d.f = 5, p = 0.0003), indicating substantial variation in effect sizes. Furthermore, the likelihood ratio test, which compares the relative fit of two models by evaluating the ratio of their likelihoods, also revealed significant heterogeneity (Q = 34.05, d.f =5, p < 0.0001), underscoring considerable diversity across the included studies. To assess the extent of variation between studies, additional computations of heterogeneity measures were performed. The estimation of overall variance between studies, measured by tau^2, yielded a value of 1.4172, indicating a notable degree of variability in effect sizes across the included studies. Moreover, the ratio of the standard deviation of the estimated overall effect size from a random-effects meta-analysis, denoted as H, is 2.16. These findings collectively suggest that the observed differences between the studies extend beyond what would be expected by chance alone, as indicated by the i^2 value of 78.6%, which represents the total variation attributed to heterogeneity.
  
  

Conclusion

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  Adjunctive BMAC injection is a novel treatment option that has become popular due to the growing orthobiologics field and the advancement of stem cell research. Because of its relative novelty, literature regarding this treatment option is limited, however, all the studies discussed in this systematic review report positive outcomes with the majority of patients reporting minimal incidence of retear. Several studies showed the superior efficacy of the BMAC injection compared to standard of care. However, since the studies in this systematic review used an array of outcome measures, a direct comparison of outcome measures cannot be completed due to the notable degree of variability in effect as described by the heterogeneity test. There is a need for further study into adjunctive BMAC for rotator cuff pathology to evaluate the overall efficacy in treatment for rotator cuff tears. Future research into BMAC injections could also illuminate improved treatment plans that optimize better care such as the number of injections, aspirate amount, dosing, duration of treatment, and overall safety. Though the field of orthobiologics is growing and therefore BMAC usage has also grown, the limited number of randomized control studies in current literature leaves the overall efficacy of BMAC in rotator cuff tears as unknown.