Abstract:Injuries to the rotator cuff (RC) are common and could alter shoulder kinematics leading to arthritis. Synthetic and biological scaffolds are increasingly being used to bridge gaps, augment RC repair and enhance healing potential. Our review evaluates the clinical applications, safety and outcome following the use of scaffolds in massive RC repair. A search was performed using EBSCO-Hosted Medline, CINAHL, Cochrane and PubMed using various combinations of the keywords ‘rotator cuff’, ‘scaffold’, ‘biological sc… Show more
“…55 A Hypersensitivity reaction due to a native immune response towards the a-gal epitope present on the cell surface of non-primate mammals lead to high failure/retear rates. 56 However, with the newer porcine dermal xenografts (Conexa), the results are more promising; with newer technologies the matrix is made acellular without porcine DNA. In these studies, the results are comparable to human acellular dermal matrix.…”
Section: Biomaterials/scaffold Based Augmentationmentioning
confidence: 99%
“…The retention of the basement membrane and vascular channels allow for native cells to form tissue within the scaffold as the scaffold itself is resorbed and replaced. 56 In the first RCT of human dermal matrix with large (>3 cm and 2 tendon involvement) rotator cuff tears, 22 patients who underwent augmented repair were compared to 20 patients with repair only. The augmented group had significantly improved functional outcome scores (Constant and ASES scores) and tendon healing rates (85% versus 40% intact in the control group, p < 0.01) on MRI at an average follow up of 2 years.…”
Section: Biomaterials/scaffold Based Augmentationmentioning
confidence: 99%
“…X-Repair Synthasome (San Diego, CA, USA) Poly-L-lactic-acid Longo et al, 54 Richetti et al, 55 Karuppaiah & Sinha, 56 Hakimi et al, 61 Petrie, 65 Nada et al, 66 Audenaert et al 67…”
Poor tendon to bone healing following rotator cuff repair has led to the continued interest and investigation into biological augmentation. The biology of tendinopathy is not fully understood and consequently the availability of disease modifying therapeutic targets is limited. A ceiling of benefit has been reached by mechanical optimisation of rotator cuff repair and thus, in order to improve healing rates, a biological solution is required. This review focuses on the strategies to biologically augment rotator cuff disorders with an emphasis on rotator cuff repair. Leucocyte rich platelet rich plasma has been shown to improve healing rates without clinically relevant improvements in outcome scores. Similarly, improved healing rates have also been reported with bone marrow stimulation and in long-term follow-up with bone marrow concentrate. Extracellular matrix (ECM) and synthetic scaffolds can increase healing through mechanical and or biological augmentation. A potential third category of scaffold is bioinductive and has no mechanical support. Studies involving various scaffolds have shown promising results for augmentation of large to massive tears and is likely to be most beneficial when tendon quality is poor, however level I evidence is limited.
“…55 A Hypersensitivity reaction due to a native immune response towards the a-gal epitope present on the cell surface of non-primate mammals lead to high failure/retear rates. 56 However, with the newer porcine dermal xenografts (Conexa), the results are more promising; with newer technologies the matrix is made acellular without porcine DNA. In these studies, the results are comparable to human acellular dermal matrix.…”
Section: Biomaterials/scaffold Based Augmentationmentioning
confidence: 99%
“…The retention of the basement membrane and vascular channels allow for native cells to form tissue within the scaffold as the scaffold itself is resorbed and replaced. 56 In the first RCT of human dermal matrix with large (>3 cm and 2 tendon involvement) rotator cuff tears, 22 patients who underwent augmented repair were compared to 20 patients with repair only. The augmented group had significantly improved functional outcome scores (Constant and ASES scores) and tendon healing rates (85% versus 40% intact in the control group, p < 0.01) on MRI at an average follow up of 2 years.…”
Section: Biomaterials/scaffold Based Augmentationmentioning
confidence: 99%
“…X-Repair Synthasome (San Diego, CA, USA) Poly-L-lactic-acid Longo et al, 54 Richetti et al, 55 Karuppaiah & Sinha, 56 Hakimi et al, 61 Petrie, 65 Nada et al, 66 Audenaert et al 67…”
Poor tendon to bone healing following rotator cuff repair has led to the continued interest and investigation into biological augmentation. The biology of tendinopathy is not fully understood and consequently the availability of disease modifying therapeutic targets is limited. A ceiling of benefit has been reached by mechanical optimisation of rotator cuff repair and thus, in order to improve healing rates, a biological solution is required. This review focuses on the strategies to biologically augment rotator cuff disorders with an emphasis on rotator cuff repair. Leucocyte rich platelet rich plasma has been shown to improve healing rates without clinically relevant improvements in outcome scores. Similarly, improved healing rates have also been reported with bone marrow stimulation and in long-term follow-up with bone marrow concentrate. Extracellular matrix (ECM) and synthetic scaffolds can increase healing through mechanical and or biological augmentation. A potential third category of scaffold is bioinductive and has no mechanical support. Studies involving various scaffolds have shown promising results for augmentation of large to massive tears and is likely to be most beneficial when tendon quality is poor, however level I evidence is limited.
“…Compared with superior capsule reconstruction in which structural restoration of the rotator cuff is given up, 7 , 8 rotator cuff reconstruction is more reasonable when the medial rotator cuff structure is usable. 9 , 10 Fig 16 Preoperative (A) and postoperative (B) coronal view magnetic resonance images of left shoulder. (A) The lateral edge of the rotator cuff (arrow).…”
Irreparable posterior-superior rotator cuff tear is encountered quite often in clinical practice. Bridging the tendon defect with various materials is reasonable. However, optimal bridging structures and techniques are still being pursued. We introduce a rotator cuff bridging technique, rooting rotator cuff reconstruction. In this technique, autogenous tendon is used to make grafts. On the medial side, the graft tendons are suspended on the rotator cuff tendon. On the lateral side, the graft tendons are placed into tunnels through the tuberosities. The most critical steps of this technique are properly fabricating the humeral tunnels and suspending the graft tendons onto the rotator cuff tendon. We believe this technique will shed light on rotator cuff reconstruction.
“…The reported retear risk following RCT surgical reparation varied from 10.3% to 94%. 35 , 40 , 41 This disparity present across studies probably results from a non-uniformity regarding the retear definition, tear sizes considered, surgical and postoperative imaging techniques, and many other criteria, and reflects the multifactorial character of retearing. 35 , 40 , 41 …”
Section: Treatment Of Patients With Rotator Cuff Tear and Scapular Dyskinesismentioning
Scapular dyskinesis can be present in healthy individuals as in patients with shoulder pathology. Altered patterns of scapular kinematics can cause or exacerbate rotator cuff tear pathology. However, more research is needed. Regardless of the cause or the consequence of rotator cuff tear, scapular dyskinesis impairs shoulder function, worsens the symptoms, and compromises the success of clinical intervention. The available literature suggests physical therapy as the first treatment for degenerative cuff tears, and scapular dyskinesis should be addressed if present. Non-responsive cases or traumatic tears may require surgery. Postsurgical physical therapy protocols after rotator cuff repair must consider scapular dyskinesia to improve the outcomes. Cite this article: EFORT Open Rev 2021;6:932-940. DOI: 10.1302/2058-5241.6.210043
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