Editorial Commentary: Don't Pig Out When Selecting a Shoulder, Rotator Cuff Augmentation Graft! Xenografts Are Not the Way to Go

Abstract

Porcine xenograft dermal onlay augmentation of rotator cuff repair does not provide improved cuff integrity or provide better clinical outcomes. The retear rate was actually higher in repairs augmented with a porcine xenograft than the control group. Adverse events occurred in 60% of the xenograft patients compared with 40% of the controls. The use of liquid platelet-rich plasma had no discernible impact. A total of 85% of the observed failures with the suture-bridging double-row repair were at the medial cuff (Cho type 2).

Loading Mesenchymal Stem Cell–Derived Exosomes Into a Traditionally Designed Rotator Cuff Patch: A Potential Strategy to Enhance the Repair of Chronic Rotator Cuff Tear Associated With Degenerative Changes

“…13 Several recent studies have confirmed the efficacy of synthetic grafts or allografts using the augmentation or interposition technique, but not of xenografts. 1,2,13,16,20,24 The potential mechanism for this is that xenografts contain too much xenogeneic deoxyribonucleic acid residue to provoke a vigorous immunogenic response, leading to scar tissue formation at the repair site. 16,20 Single augmentation repair reportedly provides strong support and reduces retear rates but cannot prevent degeneration changes such as fatty infiltration, which is consistent with the present findings.…”

“…1,4,22,31 However, some poorer outcomes of patch augmentation repair have also been seen in clinical practice, especially regarding patches derived from xenografts. 1,2,13,16,20,24 A multicenter study comparing open rotator cuff repair with augmented repair with a small intestine submucosal patch found that both groups had similar functional scores at 1 year postoperatively, while the augmented group had higher failure rates than the nonaugmented group. 13 Several recent studies have confirmed the efficacy of synthetic grafts or allografts using the augmentation or interposition technique, but not of xenografts.…”

“…23,39 Third, the patch should be biocompatible so that it does not stimulate a foreign body reaction. 2,16,20 Waterborne polyurethane (WBPU) is a Food and Drug Administration–approved material that has been widely used in medical engineering fields owning to its good biocompatibility and strength. 15,18 Moreover, WBPU can be mixed with bioactive growth factors in water instead of in organic solvents with biological toxicity that could lead to the loss of the bioactivity of growth factors.…”

Evaluation of the Cell Behavior and Growth Characteristics of the Porcine Dermal Xenograft Patch in Relation to the Surface Properties

“…Synthetic grafts can be categorized as degradable and non-degradable with superior strength, consistency, and durability ( Ono et al, 2016 ). The xenografts are porcine-derived acellular dermal matrix scaffolds and were popularized as a low-cost alternative to the human-derived allografts ( Barber, 2018 ; Flury et al, 2018 ; Kalina et al, 2019 ; Polacek, 2019 ; Ravenscroft et al, 2019 ). Today, the superiority of dermal xenografts is still debated because they are cheaper and easier to obtain.…”

The use of a patch to augment rotator cuff surgery – A survey of UK shoulder and elbow surgeons

“…Of the two RCTs identified in a previous review, one evaluated a patch derived from porcine small intestine that has since been removed from the market due to safety concerns. [7,8] It is unclear what the current practice is regarding patch use.…”