Synthetic Augmentation in Massive Rotator Cuff Tears

Abstract

Massive rotator cuff tears represent a great challenge in orthopaedic. They are associated with persistent defects, weakness, and poor outcomes and can cause an uncoupling of forces across the glenohumeral joint, with unstable shoulder kinematics. In the last few years, a notable interest has emerged to develop new treatment strategies that provide effective mechanical reinforcement of rotator cuff repair and stimulate and enhance the patient's intrinsic healing potential. Tissue engineering techniques using novel scaffold materials offer potential alternatives for managing massive irreparable rotator cuff tears. Synthetic scaffolds, manufactured from chemical compounds, have gained much interest to bridge massive rotator cuff tears. Preliminary studies support the idea that synthetic scaffolds can provide an alternative for rotator cuff augmentation with an enormous therapeutic potential. Despite the growing clinical use of synthetic scaffold devices for rotator cuff repair, there are numerous questions related to their indication, surgical application, safety, mechanism of action, and efficacy that remain to be clarified or addressed. We review the current basic science and clinical understanding of synthetic scaffolds for massive rotator cuff repair, reporting the preclinical and clinical studies carried out to date in this field. We underline the benefits and limitations of the available synthetic scaffolds for augmentation of rotator cuff tears, and discuss the implications of these literature data on the future directions for the use of these scaffolds in tendon repair procedures.

Mini-Open Suture Bridge Repair with Porcine Dermal Patch Augmentation for Massive Rotator Cuff Tear: Surgical Technique and Preliminary Results

“…The rationale for the use of such scaffold devices includes mechanical augmentation by off-loading the repair at time zero and for a period of postoperative healing, biological augmentation, by improving the rate and quality of healing, or both 8,29). Although the validity of scaffolds and the advantages their use have been demonstrated in animal studies, clinical data to support their use are limited 15,17,18,19).…”

Rotary Hood Massive Break Solutions? Massive Rotator Cuff Tear Solutions?

“…Biologicals may further be subdivided into autologous (long portion of the biceps) or allografts (derived from the dermis or submucosa of the small intestine) [2,43,44]. Discontinuation or moderation of the use of synthetic and submucosal grafts has been recommended because of the risk of inflammatory response and foreign body reaction [2,10,44,45].…”

Role of Scaffolds in the Reconstruction of Anterior Cruciate Ligament of Knee-Systematic Review

“…The other options the present commercially available scaffolds can be coated with growth factors like fibroblast growth factors which promote healing and bone morphogenic proteins which can also help in healing at the bone scaffold interface [35] . An interesting study by Murray et al observed the effects of several growth factors on cell migration, proliferation and collagen production in human ACL cells [36] .…”

“…The authors proposed that the addition of selected growth factors to an implantable scaffold may facilitate ligament healing in the gap between the ruptured ends of the human ACL. Recently many studies have stressed the importance of use of gene therapy and growth factors to enhance tendon and ligament healing [35] . However, they are still in the experimental stage and have not reached the clinical studies.…”