Patch Augmentation in Rotator Cuff Repair
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Patch Augmentation in Rotator Cuff Repair Peter N. Chalmers 1 & Robert Z. Tashjian 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of the Review Rotator cuff repair has excellent outcomes for many patients but continues to be suboptimal for large, retracted tears, and revision procedures. In these situations, patch augmentation may be considered in order to improve healing. The purpose of this article is to review the history, graft options, indications, surgical technique, outcomes, and complications associated with arthroscopic patch augmentation for rotator cuff repair. Recent Findings Patch augmentation has been shown in several studies to improve healing rates. After multiple investigations into different materials available for patch augmentation, acellular dermal allograft seems to be the graft with the best scientific support. While multiple techniques have been presented, few studies have compared their performance. Summary While the arthroscopic technique for patch augmentation can be challenging, we present a systematic approach to this procedure with the potential to reliably and predictably perform patch augmentation. This technique is a valuable tool for surgeons that treat rotator cuff pathology. Keywords Rotator cuff repair . Patch augmentation . Dermal allograft . Surgical technique . Biologic augmentation
Introduction The structural outcomes following rotator cuff repair continue to be suboptimal, with high re-tear rates reported in many series [1–3]. The natural history of rotator cuff tears is not necessarily benign, with progression in tear size, muscular atrophy, and eventually the development of the characteristic articular degenerative changes of rotator cuff tear arthropathy [1,3,6]. Consequently, the primary goal of rotator cuff repair should be a healed tendon-bone interface. Several studies have shown that if a rotator cuff repair heals, good outcomes are usually maintained in the long-term [1, 4, 7]. Thus, there has been substantial research focus and commercial investment directed to increase the likelihood of tendon healing, with much of the focus being upon the number and arrangement of anchors and other factors to improve the mechanical
This article is part of the Topical Collection on Surgical Management of Massive Irreparable Cuff Tears * Peter N. Chalmers [email protected] 1
Division of Sports Medicine, Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
properties of the repair [2, 5, 8]. However, despite decades of research and investment in repair techniques, little to no progress seem to have been made in reducing re-tear rates after rotator cuff repair [4, 10, 11••]. There is thus a somewhat urgent need for innovative treatment alternatives that will allow surgeons to improve healing rates after rotator cuff repair, and they likely involve biologic augmentation (Table 1).
Patch Augmentation Types Patch augmentation of rotator cuff repair may potentially fill the gap described above. After early re
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