Porcine Dermis Patch Augmentation of Supraspinatus Tendon Repairs: A Pilot Study Assessing Tendon Integrity and Shoulder Function 2 Years After Arthroscopic Repair in Patients Aged 60 Years or Older

Flury, Manuel; Rickenbacher, Dominik; Jung, Christian; Schneider, M. M.; Endell, David; Audigé, Laurent

doi:10.1016/j.arthro.2017.06.024

Cited by 38 publications

(14 citation statements)

References 55 publications

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“…When compared with standard repair, two RCTs investigating porcine SIS xenograft (Restore) found no difference in the physical or mental components of SF-36. 35 39 Similarly, an RCT (Avanzi et al ) 37 and an observational comparative study (Flury et al ) 41 assessing different DXs did not find an improved EQ-5D at 2-year follow-up. Conversely, a comparative study using human allograft (Athroflex) reported a significant improvement in all components of SF-12 at 6 months and 2 years postoperatively (though not at 3 months).…”

Section: Resultsmentioning

confidence: 94%

“…In conflict with these findings, a multipatch comparative study 29 found no difference in failure rate between xenograft (Restore) and two different patches; human allograft (Graftjacket) or synthetic (Artelon). Among the observational comparative studies, significantly lower rates of re-tears were reported with augmentation using synthetic (Repol Angimesh), 30 autograft (fascia lata) 13 or allograft patches (Arthroflex and Allocover), 40 45 while no improvement in re-tears was observed following augmentation with DX (reinforcement matrix), 41 long head of biceps tendon autograft 43 or for the Restore 34 patch.…”

Section: Resultsmentioning

confidence: 99%

“…Only two studies (Gilot et al , Athroflex; 41 Mori et al , fascia lata 13 ) reported significant reduction in pain when compared against standard repair ( online supplemental table 6 ). Interestingly, the study by Walton et al, who used a ‘mean activity pain score’, found an increase in pain for the first 3 months following implantation of the Restore patch, which subsequently normalised by 6 months.…”

Section: Resultsmentioning

confidence: 99%

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Use of implantable meshes for augmented rotator cuff repair: a systematic review and meta-analysis

et al. 2020

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ObjectiveTo appraise studies reporting on clinical effectiveness and safety of surgical meshes used to augment rotator cuff repairs (RCRs).DesignSystematic review and meta-analysis.Data sourcesMEDLINE, Embase and Cochrane databases were searched between April 2006 and April 2020.Eligibility criteriaAll studies evaluating adults (≥18 years) undergoing RCR were considered. There were no language restrictions.Data extraction and synthesisScreening, data extraction and quality appraisal were conducted by two independent reviewers. Meta-analysis was conducted using a random-effects models if ≥2 comparative studies reported the same outcome measure. Risk of bias assessment was undertaken for randomised (RoB2, Cochrane) and comparative studies (ROBINS-I, Cochrane).ResultsWe included 60 studies, consisting of 7 randomised controlled trials, 13 observational comparative studies and 40 observational case series. All comparative studies reported on shoulder-specific functional outcome scores, 18 on the radiographic occurrence of re-tear and 14 on pain score metrics. All studies contained some risk of bias.Compared with non-augmented repair, a small improvement in shoulder-specific function or pain scores was observed for synthetic patches with a mean improvement of 6.7 points on the University of California Los Angles (UCLA) shoulder score (95% CI 0.1 to 13.4) and 0.46 point reduction on the Visual Analogue Scale (95% CI −0.74 to −0.17), respectively. A reduced likelihood of radiologically observed re-tear was observed for synthetic (risk ratio (RR) 0.41, 95% CI 0.27 to 0.61) and allograft (RR 0.34, 95% CI 0.18 to 0.65) patches. A total of 49 studies reported on the occurrence of complications. Slightly higher crude complication rates were observed following patch-augmented repair (2.1%) than standard repair (1.6%).ConclusionsWhile several studies suggest a decreased failure rate and small improvements in shoulder function and pain following augmented RCR, a paucity of rigorous clinical evaluation, for both effectiveness and safety, prevents firm recommendations.Prospero registration numberCRD42017057908.

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Section: Resultsmentioning

confidence: 94%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Use of implantable meshes for augmented rotator cuff repair: a systematic review and meta-analysis

et al. 2020

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“…Arthroscopic superior capsule reconstruction, introduced by Mihata et al 12 using fascia lata, later commonly replaced by dermal patches, is probably the fastest growing solution for this indication. 13 Other less popular or newer options are subacromial balloon spacer implantation, multipletendon interposition autografts, and augmentation of the long head of the biceps. [14][15][16][17] In addition, tendon transfers such as latissimus dorsi and lower trapezius transfer have been popularized for this indication.…”

Section: See Related Article On Page 2080mentioning

confidence: 99%

Editorial Commentary: Rotator Cuff Tear: Know When Not to Operate So You Don't Make It Worse

Heerspink

Dorrestijn²

2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Shoulder rotator cuff repair results in significantly improved outcomes compared with conservative treatment, but some repairs result in retear and, worst of all, enlarged retears (i.e., tears larger after surgery than primarily). Elevated serum total cholesterol and low-density lipoprotein levels and fatty infiltration of the infraspinatus are significantly related to symptomatic failed rotator cuff repair. Hypertension could also be a risk factor. In such cases, nonoperative treatment, reverse shoulder prosthesis (in older patients), or alternative joint-preserving procedures (superior capsular reconstruction, subacromial balloon spacer, multiple-tendon interposition autografts, augmentation of the long head of the biceps, or tendon transfers such as latissimus dorsi transfer and lower trapezius transfer) could be considered or are worthy of future investigation.

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“…Based on the recent literature, allografts made of acellular human dermis are thought to provide the most beneficial clinical outcome with low rerupture rates compared to other scaffolds [ 14 – 16 ]. In the current literature, the clinical outcome of xenografts is discussed controversially [ 7 , 17 , 18 ]. Thus, the source of the graft plays an important role [ 4 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

In Vivo Evaluation of Different Collagen Scaffolds in an Achilles Tendon Defect Model

Gabler

Sass

Gierschner

et al. 2018

BioMed Research International

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In the present study, a newly introduced bovine cross-linked collagen scaffold (test material) was investigated in vivo in an Achilles tendon defect model and compared to a commercially available porcine collagen scaffold (control material). In total, 28 male Sprague Dawley rats (about 400 g) were examined. The defined Achilles tendon defect of 5 mm of the right hind limb was replaced by one of the scaffold materials. After euthanasia, the hind limbs were transected for testing. Biomechanical evaluation was carried out via tensile testing (n = 8 each group, observation time: 28 days). Nonoperated tendons from the bilateral side were used as a control (native tendon, n = 4). For the histological evaluation, 12 animals were sacrificed at 14 and 28 days postoperatively (n = 3 each group and time point). Stained slices (Hematoxylin & Eosin) were evaluated qualitatively in terms of presence of cells and cell migration into scaffolds as well as structure and degradation of the scaffold. All transected hind limbs were additionally analyzed using MRI before testing to verify if the tendon repair using a collagen scaffold was still intact after the observation period. The maximum failure loads of both scaffold materials (test material: 54.5 ± 16.4 N, control: 63.1 ± 19.5 N) were in the range of native tendon (76.6 ± 11.6 N, p ≥ 0.07). The stiffness of native tendons was twofold higher (p ≤ 0.01) and the tear strength was approximately fivefold higher (p ≤ 0.01) compared to the repaired tendons with both scaffolds. Histological findings indicated that neither the test nor the control material induced inflammation, but the test material underwent a slower remodeling process. An overall repair failure rate of 48% was observed via MRI. The experimental data of the newly developed test material showed similar outcomes compared to the commercially available control material. The high repair failure rate indicated that MRI is recommended as an auxiliary measurement tool to validate experimental data.

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Porcine Dermis Patch Augmentation of Supraspinatus Tendon Repairs: A Pilot Study Assessing Tendon Integrity and Shoulder Function 2 Years After Arthroscopic Repair in Patients Aged 60 Years or Older

Cited by 38 publications

References 55 publications

Use of implantable meshes for augmented rotator cuff repair: a systematic review and meta-analysis

Use of implantable meshes for augmented rotator cuff repair: a systematic review and meta-analysis

Editorial Commentary: Rotator Cuff Tear: Know When Not to Operate So You Don't Make It Worse

In Vivo Evaluation of Different Collagen Scaffolds in an Achilles Tendon Defect Model

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