Biologic and Synthetic Grafts in the Reconstruction of Large to Massive Rotator Cuff Tears

Abstract

Rotator cuff injuries are common in both young and elderly patients. Despite improvements in instrumentation and surgical techniques, the failure rates following tendon reconstruction remain unacceptably high. To improve outcomes, graft patches have been developed to provide mechanical strength and to furnish a scaffold for biologic growth across the delicate tendon-bone junction. Although no patch effectively re-creates the structured, highly organized system of prenatal tendon development, augmenting rotator cuff repair may help restore native tendon-to-bone attachment while reproducing the mechanical and biologic properties of native tendon. An understanding of biologically and synthetically derived grafts, along with knowledge of the preliminary data available regarding their combined use with growth factors and stem cells, is needed to improve management and treatment outcomes. The current literature has not been consistent in showing patch augmentation to be beneficial over traditional repair, but novel scaffolding materials may help facilitate rotator cuff tendon repair that is histologically and biomechanically comparable to native tendon.

Tendon injury and repair – A perspective on the basic mechanisms of tendon disease and future clinical therapy

“…Synthetic grafts have therefore been exploited for repair, as reviewed recently [187,245,246], ranging from grafts based on e.g. polyester [247][248][249][250][251], polypropylene [252,253], polyethelene(-terephthalate) [254][255][256][257][258] and carbon [259,260].…”

Woven collagen biotextiles enable mechanically functional rotator cuff tendon regeneration during repair of segmental tendon defects in vivo

“…While many current approaches augmenting rotator cuff tendon healing focus on utilization of synthetic or natural materials to augment and accelerate repair, several setbacks using these approaches have been identified. Material composition is a major concern, as synthetic materials capable of possessing appropriate mechanical properties are easy to produce however these materials often fail to provide the biological cues necessary to stimulate and guide tissue integration.…”

“…Given the need for more effective treatment approaches to restore function to damaged tendons, many biomaterials, engineered tissue replacements, and biologics are under active investigation. Experimental strategies to promote tendon healing that are currently being explored include the use of decellularized matrices, biodegradable polymer scaffolds, growth factor administration, genetic reprogramming, and mechanical stimulation …”

The Role of Biologic Therapy in Rotator Cuff Tears and Repairs

“…Synthetic grafts or scaffolds, composed of various materials including polypropylene, Dacron, and even nylon [64], have had success in terms of re-tear rates [61•]. Synthetic material is often stronger biomechanically and does not have the theoretical risk of vector transmission [65,66].…”