Benefits of Patch Augmentation on Rotator Cuff Repair: A Systematic Review and Meta-analysis

Abstract

Background: Despite technological advances, the overall retear rate on rotator cuff repair is still high. Patches have shown significant reduction in retear rate and pain scores; however, this is not a universal finding and conflicting results have been shown among functional shoulder scales. Purpose: To analyze previous controlled trials of the literature to bring a consensus about the effectiveness of patch use on rotator cuff repair. Study Design: Systematic review; Level of evidence, 1. Methods: The search was conducted in PubMed, Web of Science, EMBASE, Scopus, and Cochrane in April 2020. The results of rotator cuff repair with patch augmentation versus without augmentation (control) were compared through odds ratio (OR), raw mean difference (RMD), and standardized mean difference (SMD) of retear rate; functional shoulder scales; strength; and range of motion (ROM). Results: Of 733 initial studies, 7 of them met the criteria to be included in the analysis. Compared with the control group, the patch augmentation group had a significantly lower retear rate (OR, 0.32 [95% CI, 0.18 to 0.55]; P < .001), lower pain (SMD, –0.42 [–0.71 to –0.12]; P < .01), a higher University of California Los Angeles Shoulder Rating Scale (RMD, 0.87 [0.15 to 1.60], P = .017), and a trend toward higher strength (SMD, 0.95 [–0.03 to 1.94], P = .05) and lower forward elevation ROM (RMD, –10.50 [–21.86 to 0.67]; P = .06), while no changes were noted for other functional scales or for internal and external rotation ROM. Conclusion: The results point to benefits of patch augmentation in rotator cuff repair, particularly a reduction in retear rate. More interventional studies with better methodological quality should be conducted to confirm the results of this initial review.

Human Dermal Allograft Patch Augmentation of Degenerate Rotator Cuff Tendon Using a Single Lateral-Row Technique

“…Arthroscopic rotator cuff patch augmentation or interposition surgery has grown in popularity over the years, with systematic reviews and meta-analysis showing that these methods provide better shoulder scores compared with rotator cuff repair alone. 15 , 16 A variety of grafts are available, ranging from xenograft, synthetic grafts, autograft, and allograft. 10 Xenografts that were available included porcine dermal xenograft; however, these grafts were associated with severe inflammatory reactions, and Flury et al.…”

Rotator Cuff Repair With a Novel Interpositional Allograft Augmentation

“…The relative efficacy of various patch options, including allografts, xenografts, synthetic polymers, and autografts, remains unproven. 4 Clinical outcomes assessment of the biphasic interpositional allograft is ongoing.…”

Patch augmentation in patients with large to massive rotator cuff tear

“…In terms of re-tear rate, patch augmentation in rotator cuff repair showed a lower rate than repair without patch augmentation, according to a recent meta-analysis study [ 9 ]. However, the effect on clinical outcomes was not clinically meaningful.…”

“…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.…”