Question 1

Will I be charged extra if my surgeon adds a biologic during my surgery?

Accepted Answer

Often, yes. Some biologic add-ons, particularly implants like Regeneten and techniques like BMAC, carry additional cost that may not be fully covered by insurance even when the primary surgery is covered. Ask your surgeon's office specifically which add-ons are being planned and what the expected cost exposure is before your procedure.

Question 2

Does adding Regeneten to my cuff repair mean I'll definitely have a better outcome?

Accepted Answer

Not necessarily in terms of how you'll feel. The strongest trial on this implant found a large reduction in retear rates on MRI but no significant difference in patient-reported pain and function scores between the implant and non-implant groups at two years. It appears to make the repair structurally more durable; whether that translates into a better subjective outcome for you individually isn't proven yet.

Question 3

What is BMAC, and is it the same as a stem cell injection?

Accepted Answer

BMAC stands for bone marrow aspirate concentrate. It is made from your own bone marrow, drawn during surgery and concentrated in a centrifuge, and it is not a cultured or donor-derived stem cell product. In a randomized trial adding BMAC to rotator cuff repair, it reduced the structural retear rate substantially but did not change patient-reported outcomes compared with repair alone.

Question 4

Why would marrow venting be added to my meniscus repair?

Accepted Answer

Marrow venting creates small holes near the meniscal repair site to release bone marrow cells and growth factors into the joint, mimicking a biologic exposure that happens automatically during ACL reconstruction. In a cohort study, isolated meniscal repairs augmented with marrow venting achieved survivorship comparable to repairs performed alongside ACL reconstruction, suggesting the technique helps close that biological gap when no ACL surgery is being done at the same time.

Question 5

Does PRP added during rotator cuff surgery work better than PRP given as a standalone injection?

Accepted Answer

The evidence is more favorable for PRP used during surgery, at least for large and massive tears. A randomized trial found that PRP applied at the time of repair improved tendon-to-bone healing signal on MRI and 12-month pain and function scores. That is a more consistent result than PRP has shown as a standalone injection for chronic tendinopathy without surgery, where a separate placebo-controlled trial found no benefit.

Question 6

Are these biologic add-ons used for every patient having cuff or meniscal surgery in Montgomery County with Dr. Raffo?

Accepted Answer

No. Dr. Raffo selects among Regeneten, PRP, marrow venting, and BMAC based on tear size, tissue quality, and whether a concurrent ligament reconstruction is being performed, rather than adding a biologic to every case performed at his Bethesda and Germantown surgical sites. Some patients having a straightforward repair with good tissue quality will not have any biologic added at all.

Question 7

If the trial data show no functional benefit for some of these add-ons, why use them?

Accepted Answer

Because retear on imaging and patient-reported symptoms are two different outcomes, and a structurally intact repair may still matter over a longer time horizon than most trials have followed patients — for tendon durability with future use, or for avoiding a second surgery down the line. Dr. Raffo discusses this distinction directly with patients rather than implying a structural benefit automatically means a better day-to-day result.

Biologic Augmentation During Surgery

Overview

Who Is This For?

Biologics Used

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Frequently Asked Questions

Related Procedures

Arthroscopic Rotator Cuff Repair

Rotator Cuff Repair with REGENETEN Bioinductive Implant

Partial-Thickness Rotator Cuff Tear Treatment

Meniscus Repair

Biologics in Orthopedic Practice

Platelet-Rich Plasma (PRP)