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Bone marrow-stimulating techniques in arthroscopic rotator cuff repair: a systematic review protocol
  1. Liang-Tseng Kuo1,2,
  2. Chi-Lung Chen1,
  3. Pei-An Yu1,
  4. Yu-Shiun Tsai2,
  5. Wei-Hsiu Hsu1,3,
  6. Ching-Chi Chi2,3,4,
  7. Jae Chul Yoo5
  1. 1 Division of Sports Medicine, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Chiayi, Taiwan
  2. 2 Center of Evidence-Based Medicine, Chang Gung Memorial Hospital, Chaiyi, Chiayi, Taiwan
  3. 3 College of Medicine, Chang Gung University, Taoyuan, Taiwan
  4. 4 Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
  5. 5 Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
  1. Correspondence to Professor Ching-Chi Chi; chingchichi{at}


Introduction Bone marrow-stimulating (BMS) techniques during arthroscopic rotator cuff repair surgery theoretically enhance the biological component for healing and hence improve tendon healing, but their efficacy remains unproven. The purpose of this review is to determine the effects and associated harms of BMS in arthroscopic rotator cuff repair surgery.

Methods and analysis We will perform a systematic review and meta-analysis of randomised-controlled trials (RCTs) and retrospective cohort studies (RCS) that compare outcomes following BMS use against no use of BMS during arthroscopic rotator cuff repair surgery. We will search the databases including the Cochrane Central Register of Controlled Trials, Medline and Embase, and clinical trial registries for relevant studies. We will include studies published from start of indexing until 23 August 2018. Two reviewers will independently assess the eligibility for studies. For each included trial, we will conduct duplicate independent data extraction and risk of bias assessment. We will use the Cochrane Collaboration tool to assess the risk of bias of included RCTs, while we will use the Risk Of Bias In Non-randomised Studies - of Interventions tool to evaluate the risk of bias of RCS. We will perform a random-effects meta-analysis in calculating the pooled risk estimates when appropriate. We will assess the overall quality of the data for each individual outcome using the Grading of Recommendations, Assessments, Development and Evaluation approach. The primary outcomes are tendon healing rate, overall pain and shoulder functions. The secondary outcomes are the proportion of participants with adverse events related to interventions, the range of motion and the proportion of participants with return to previous activities.

Ethics and dissemination We will report this review according to the guidance of the PRISMA statement. The results of this review will be disseminated through conference presentations and publications in peer-reviewed journals.

PROSPERO registration number CRD42018087161.

  • shoulder
  • musculoskeletal disorders

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  • Contributors L-TK and JCY conceived the idea for this systematic review. L-TK, C-LC, P-AY, W-HH, C-CC and JCY developed the methodology for the systematic review protocol. The manuscript was drafted by L-TK and C-LC and revised by W-HH, C-CC, JCY. Y-ST developed the search strategy. L-TK and P-AY will screen potential studies, perform duplicate independent data extraction, risk of bias assessment, GRADE assessment. C-LC will conduct the data synthesis. C-CC with act as a third reviewer and arbitrator if necessary. C-CC is the guarantor of the review. All authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data from this study are available.

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