Does Additional Biceps Augmentation Improve Rotator Cuff Healing and Clinical Outcomes in Anterior L-Shaped Rotator Cuff Tears? Clinical Comparisons With Arthroscopic Partial Repair

Jeon, Young-Chan; Lee, Juyeob; Kim, Rag Gyu; Ko, Young Won; Shin, Sang Jin

doi:10.1177/0363546517720198

Cited by 27 publications

(28 citation statements)

References 21 publications

(32 reference statements)

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“…In conflict with these findings, a multipatch comparative study 29 found no difference in failure rate between xenograft (Restore) and two different patches; human allograft (Graftjacket) or synthetic (Artelon). Among the observational comparative studies, significantly lower rates of re-tears were reported with augmentation using synthetic (Repol Angimesh), 30 autograft (fascia lata) 13 or allograft patches (Arthroflex and Allocover), 40 45 while no improvement in re-tears was observed following augmentation with DX (reinforcement matrix), 41 long head of biceps tendon autograft 43 or for the Restore 34 patch.…”

Section: Resultsmentioning

confidence: 99%

Use of implantable meshes for augmented rotator cuff repair: a systematic review and meta-analysis

et al. 2020

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ObjectiveTo appraise studies reporting on clinical effectiveness and safety of surgical meshes used to augment rotator cuff repairs (RCRs).DesignSystematic review and meta-analysis.Data sourcesMEDLINE, Embase and Cochrane databases were searched between April 2006 and April 2020.Eligibility criteriaAll studies evaluating adults (≥18 years) undergoing RCR were considered. There were no language restrictions.Data extraction and synthesisScreening, data extraction and quality appraisal were conducted by two independent reviewers. Meta-analysis was conducted using a random-effects models if ≥2 comparative studies reported the same outcome measure. Risk of bias assessment was undertaken for randomised (RoB2, Cochrane) and comparative studies (ROBINS-I, Cochrane).ResultsWe included 60 studies, consisting of 7 randomised controlled trials, 13 observational comparative studies and 40 observational case series. All comparative studies reported on shoulder-specific functional outcome scores, 18 on the radiographic occurrence of re-tear and 14 on pain score metrics. All studies contained some risk of bias.Compared with non-augmented repair, a small improvement in shoulder-specific function or pain scores was observed for synthetic patches with a mean improvement of 6.7 points on the University of California Los Angles (UCLA) shoulder score (95% CI 0.1 to 13.4) and 0.46 point reduction on the Visual Analogue Scale (95% CI −0.74 to −0.17), respectively. A reduced likelihood of radiologically observed re-tear was observed for synthetic (risk ratio (RR) 0.41, 95% CI 0.27 to 0.61) and allograft (RR 0.34, 95% CI 0.18 to 0.65) patches. A total of 49 studies reported on the occurrence of complications. Slightly higher crude complication rates were observed following patch-augmented repair (2.1%) than standard repair (1.6%).ConclusionsWhile several studies suggest a decreased failure rate and small improvements in shoulder function and pain following augmented RCR, a paucity of rigorous clinical evaluation, for both effectiveness and safety, prevents firm recommendations.Prospero registration numberCRD42017057908.

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Section: Resultsmentioning

confidence: 99%

Use of implantable meshes for augmented rotator cuff repair: a systematic review and meta-analysis

et al. 2020

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“…Biceps augmentation in a different direction or partial repair has been introduced as a surgical repair technique for anterior L-shaped rotator cuff tear. Jeon et al 4 compared biceps augmentation that was performed to cover the cuff footprint in the anterior-to-posterior direction by cutting the tendon insertion and partial repair for an anterior L-shaped rotator cuff tear. Despite improved postoperative shoulder function, the retear rate of the 2 techniques was not significantly different (32% in biceps augmentation vs 39% in partial repair).…”

Section: Discussionmentioning

confidence: 99%

“…The rotator cuff tear pattern is recognized by preoperative magnetic resonance imaging and confirmed during arthroscopic surgery. An anterior L-shaped rotator cuff tear is defined as a tear that is longer in the medial-to-lateral direction than in the anterior-toposterior direction, with exposure of the biceps tendon 4 (Fig 1A, B).…”

Section: Surgical Technique Preoperative Evaluationmentioning

confidence: 99%

Anterior Cable Reconstruction Using the Biceps Tendon in Retracted Anterior L-Shaped Rotator Cuff Tears

Shin

Kim

Park

et al. 2021

Arthroscopy Techniques

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“…Interestingly, radiological findings seemed to closely echo patient-reported outcome measures (PROMs). Three studies 35,65,67 found no significant improvement in either PROMs or rate of re-tear, whereas a further five studies 26,33,40,42,68 reported significant improvements in both functional outcome scores and radiologically defined repair failure. This lends support to the notion that repair success is intimately linked with symptom resolution.…”

Section: Total (95% Ci)mentioning

confidence: 94%

“…30 Among the observational comparative studies, significantly lower rates of re-tears were reported after augmentation with synthetic (Repol Angimesh), autograft (fascia lata) or allograft patches (Arthroflex and Allocover), whereas no improvement in re-tears was observed following augmentation with a long head of biceps tendon autograft or for the Restore patch. 33,[39][40][41][42][43]67,71 Non-comparative studies Re-tear rate was assessed by 31 non-comparative studies, with a wide range of re-tear rates reported for each graft type [human allograft (0-25%, n = 7), human autograft (7-100%, n = 4), xenograft dermal (0-63%, n = 8), xenograft intestinal (8-90%, n = 4) and synthetic (7-62%, n = 8)].…”

Section: Re-tear (Including Radiological Assessments)mentioning

confidence: 99%

Patch augmentation surgery for rotator cuff repair: the PARCS mixed-methods feasibility study

Cook

Baldwin

Cooper

et al. 2021

Health Technol Assess

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Background A rotator cuff tear is a common, disabling shoulder problem. Symptoms may include pain, weakness, lack of shoulder mobility and sleep disturbance. Many patients require surgery to repair the tear; however, there is a high failure rate. There is a need to improve the outcome of rotator cuff surgery, and the use of patch augmentation (on-lay or bridging) to provide support to the healing process and improve patient outcomes holds promise. Patches have been made using different materials (e.g. human/animal skin or tissue and synthetic materials) and processes (e.g. woven or mesh). Objectives The aim of the Patch Augmented Rotator Cuff Surgery (PARCS) feasibility study was to determine the design of a definitive randomised controlled trial assessing the clinical effectiveness and cost-effectiveness of a patch to augment surgical repair of the rotator cuff that is both acceptable to stakeholders and feasible. Design A mixed-methods feasibility study of a randomised controlled trial. Data sources MEDLINE, EMBASE and the Cochrane Library databases were searched between April 2006 and August 2018. Methods The project involved six stages: a systematic review of clinical evidence, a survey of the British Elbow and Shoulder Society’s surgical membership, a survey of surgeon triallists, focus groups and interviews with stakeholders, a two-round Delphi study administered via online questionnaires and a 2-day consensus meeting. The various stakeholders (including patients, surgeons and industry representatives) were involved in stages 2–6. Results The systematic review comprised 52 studies; only 15 were comparative and, of these, 11 were observational (search conducted in August 2018). These studies were typically small (median number of participants 26, range 5–152 participants). There was some evidence to support the use of patches, although most comparative studies were at a serious risk of bias. Little to no published clinical evidence was available for a number of patches in clinical use. The membership survey of British Elbow and Shoulder surgeons [105 (21%) responses received] identified a variety of patches in use. Twenty-four surgeons (77%) completed the triallist survey relating to trial design. Four focus groups were conducted, involving 24 stakeholders. Differing views were held on a number of aspects of trial design, including the appropriate patient population (e.g. patient age) to participate. Agreement on the key research questions and the outline of two potential randomised controlled trials were achieved through the Delphi study [29 (67%)] and the consensus meeting that 22 participants attended. Limitations The main limitation was that the findings were influenced by the participants, who are not necessarily representative of the views of the relevant stakeholder groups. Conclusion The need for further clinical studies was clear, particularly given the range and number of different patches available. Future work Randomised comparisons of on-lay patch use for completed rotator cuff repairs and bridging patch use for partial rotator cuff repairs were identified as areas for further research. The value of an observational study to assess safety concerns of patch use was also highlighted. These elements are included in the trial designs proposed in this study. Study registration The systematic review is registered as PROSPERO CRD42017057908. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 13. See the NIHR Journals Library website for further project information.

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Does Additional Biceps Augmentation Improve Rotator Cuff Healing and Clinical Outcomes in Anterior L-Shaped Rotator Cuff Tears? Clinical Comparisons With Arthroscopic Partial Repair

Cited by 27 publications

References 21 publications

Use of implantable meshes for augmented rotator cuff repair: a systematic review and meta-analysis

Use of implantable meshes for augmented rotator cuff repair: a systematic review and meta-analysis

Anterior Cable Reconstruction Using the Biceps Tendon in Retracted Anterior L-Shaped Rotator Cuff Tears

Patch augmentation surgery for rotator cuff repair: the PARCS mixed-methods feasibility study

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