Patch augmentation does not provide better clinical outcomes than arthroscopic rotator cuff repair for large to massive rotator cuff tears

Abstract

Purpose Patch augmentation for large and massive rotator cuf tears (LMRCTs) has been suggested as a repair strategy that can mechanically reinforce tendons and biologically enhance healing potential. The purpose of this study was to determine whether patients who underwent patch augmentation would have lower rates of retears and superior functional outcomes. Methods Patients who underwent arthroscopic rotator cuf repair (ARCR) with patch augmentation (group A) were matched by age, sex, degree of retraction, and supraspinatus muscle occupation ratio to those treated with ARCR without using a patch (group B) with a minimum follow-up of 24 months. The retear (Sugaya IV or V) rates were evaluated by magnetic resonance imaging at 3 and 12 months post-surgery. The Constant-Murley Score (CMS), Korean Shoulder Score (KSS), and University of California-Los Angeles Shoulder Rating Scale (UCLA) score were retrospectively analyzed. Results This study included 34 patients (group A, n = 17; group B, n = 17). The mean follow-up period was 46.5 ± 17.4 months. At postoperative 1-year follow-up, group B (6 patients, 35.3%) showed higher rates of retears than group A (1 patient, 5.9%), which was statistically signiicant (P = 0.034). However, the postoperative CMS, KSS, and UCLA scores did not difer between the two groups at 3 months, 12 months, and the inal follow-up. Additionally, the clinical outcomes of patients with retear were not signiicantly diferent from those of the healed patients in both groups. Conclusion The use of an allodermal patch for LMRCT is efective in preventing retears without complications. However, the clinical outcomes of ARCR using allodermal patch augmentation were not superior to those of only ARCR. Level of evidence III.

Tough gel adhesive is an effective method for meniscal repair in a bovine cadaveric study

“…This is an important avenue to pursue. The adhesive patch also opens the door to hybrid models, where a suture could be enhanced by the addition of a patch, as studied in the treatment of massive rotator cuff tears [52]. The patch would facilitate a more even and effective distribution of stresses on the suture.…”

Multiaxial filament winding of biopolymer microfibers with a collagen resin binder for orthobiologic medical device biomanufacturing

“…Yet, the benefits of allograft tissue in this context are limited by variable donor quality, lack of biomimetic structures, challenges associated with arthroscopic surgical delivery, and impaired healing [8]. Moreover, the use of allograft tissue for augmentation of RCRs has not been reliably associated with significant clinical benefits compared to sutureonly repairs [9]. Recently, a reconstituted freeze-dried bovine type I atelocollagen sponge exhibited a 6-12 month in situ remodeling period to help promote RCR healing via collagen biointegration.…”

Patch augmentation in patients with large to massive rotator cuff tear

“…de Andrade et al [ 9 ] found that the range of shoulder-forward flexion tended to be lower with patch augmentation. Choi et al [ 10 ] reported that clinical outcomes and range of shoulder motion did not differ between the patch augmentation group and repair only group. However, others have reported that forward elevation was increased, suggesting that patch augmentation has not yielded promising results for shoulder range of motion [ 11 , 12 ].…”