Evaluation of patches for rotator cuff repair: A systematic review and meta-analysis based on animal studies

Abstract

Based on the published animal studies, we systematically evaluated the outcomes of various materials for rotator cuff repair in animal models and the potentials of their clinical translation. 74 animal studies were finally included, of which naturally derived biomaterials were applied the most widely (50.0%), rats were the most commonly used animal model (47.0%), and autologous tissue demonstrated the best outcomes in all animal models. The biomechanical properties of naturally derived biomaterials (maximum failure load: WMD 18.68 [95%CI 7.71–29.66]; P = 0.001, and stiffness: WMD 1.30 [95%CI 0.01–2.60]; P = 0.048) was statistically significant in the rabbit model. The rabbit model showed better outcomes even though the injury was severer compared with the rat model.

A Knitted PET Patch Enhances the Maturation of Regenerated Tendons in Bridging Reconstruction of Massive Rotator Cuff Tears in a Rabbit Model

“…Although our results of the autograft group were consistent with those of Liu et al 38 and Adams et al, 2 these findings should be interpreted with caution, as previous studies only compared autografts with simple sutures, allografts, or different types of autografts. 53 Consequently, our study indicated that at least the knitted PET patch was not inferior to the autologous tendon in early tendon healing after bridging reconstruction.…”

“…5,34 Most animal studies have focused on degradable synthetic materials for patch augmentation, such as polycaprolactone (PCL), polylactic acid (PLA), poly(L-lactide) (PLLA), 15,24,57 and poly(lactic-co-glycolic acid) (PLGA), which show better outcomes than simple sutures. 53 Despite the satisfactory biocompatibility and high porosity of degradable synthetic patches, the decrease in mechanical properties may lead to uneven loading or repair failure, 34 thus limiting their application in clinical bridging reconstruction of MRCTs. Nondegradable synthetic materials, such as polyester, polyurethane urea, polytetrafluoroethylene, and polypropylene, have outstanding mechanical strength as well as long-term mechanical support, 11,13,40,41,44,45,48 whereas their hydrophobic property and inferior biocompatibility may lead to poor healing.…”

“…This study had several limitations. First, although acute infraspinatus tendon resection in a rabbit model of MRCTs has been commonly utilized to evaluate the healing process of MRCT repair, 49,53 this experimental setting may not fully represent the clinical features of chronic or degenerative MRCTs in elderly patients. Second, because postoperative observation lasted only for 12 weeks, the long-term effectiveness of the knitted PET patch and the progression of fatty infiltration after bridging reconstruction have not been fully investigated.…”

Translation of biomaterials from bench to clinic

“…A total of 24 articles [ [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] ] are included in this special issue. These articles can be categorized in terms of authors, biomaterials and targeted clinical areas, and article types.…”

“…As an emerging field, regulatory science has been gradually developed to play an important role during the translation of innovative biomaterial-based medical products. Several articles in this special issue are on regulatory science and discuss the new standards, tools, and approaches to evaluate the safety, efficacy, quality, and performance of medical products [ 10 , 13 , 17 , 19 ]. This special issue also covers a wide range of article types including research article [ [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , 11 , 12 , 15 , 16 , [18] , [19] , [20] , [23] , [24] , [25] , [26] ], reviews [ 14 , 17 , 21 , 22 , 27 ], perspectives [ 10 , 13 ] and opinion paper [ 18 ].…”