Use of a Nanofiber Resorbable Scaffold During Rotator Cuff Repair: Surgical Technique and Results After Repair of Small- to Medium-Sized Tears

Abstract

Background: The rate of retear after primary rotator cuff failure remains unacceptably high (up to 36% for small- to medium-sized tears). Augmentation of cuff repair with scaffold devices has been reported to improve healing after cuff repair. Purpose/Hypothesis: To describe the surgical technique of using an interpositional nanofiber scaffold during rotator cuff repair and report on a retrospective series of patients regarding functional outcomes and postoperative healing on magnetic resonance imaging (MRI). We hypothesized that augmentation of cuff repair with an interpositional scaffold would result in a high rate of tendon healing and excellent functional outcomes. Study Design: Case series; Level of evidence, 4. Methods: A total of 33 patients underwent arthroscopic rotator cuff repair augmented with a nanofiber, bioresorbable polymer patch secured as an inlay between the tendon and underlying bone. Patients were evaluated preoperatively and postoperatively with the Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES) shoulder score, and active range of motion (ROM) measurements. Postoperative MRI was used to evaluate repair status. Results: At a minimum follow-up of 6 months, the patients showed significant improvement on SST and ASES scores ( P < .0001 for both). ROM in forward flexion, abduction, internal rotation, and external rotation significantly improved at 6 months postoperatively ( P < .05 for all). MRI at an average of 11 months postoperatively showed healing in 91% of patients; one patient had a recurrent tear with transtendon failure, and another patient had retear at the insertional site. The patch was not visible on postoperative imaging, suggesting complete resorption in all patients. No adverse events were associated with the patch. Conclusion: Our results demonstrate the preliminary safety and efficacy of a novel, bioresorbable synthetic scaffold for rotator cuff repair. The use of the scaffold resulted in a 91% tendon healing rate and significant improvements in functional and patient-reported outcome measures. The results are promising for improving the current unacceptably high rate of rotator cuff repair failure.

Rotator Cuff Repair Augmented With Interpositional Nanofiber Scaffold

“…A recently published study reported on a retrospective cohort of patients undergoing arthroscopic rotator cuff repair with an interpositional scaffold. 7 The study showed a 9% rate of failure, primarily in the setting of large or massive tear patterns, which are known to be associated with increased rates of failure. 2 , 3 When small- to medium-sized tears, which comprised most of this cohort, were segregated, a 97% healing rate was noted based on postoperative magnetic resonance imaging analysis.…”

“…It has shown promising early results in both animal and human studies. 7 , 8 The purpose of this article is to describe the technique for use of this interpositional nanofiber scaffold in the setting of an arthroscopic rotator cuff repair.…”

Nanofibrous scaffolds for the healing of the fibrocartilaginous enthesis: advances and prospects

“…Meanwhile, as a synthetic scaffold, it can decrease inflammatory reaction and cause less scarring at the fibrocartilaginous enthesis than biological scaffolds. 99 In a rabbit model of anterior fork ligament injury, the researchers wrapped biomimetic nanofiber membranes around autologous hamstring tendons. Eight weeks after surgery, they found that the biomimetic nanofibrous membrane formed new bone tissue between the tendon and bone, possibly because its biodegradable nanofibrous membrane facilitated the penetration of bone tissue into the fibrocartilaginous enthesis and promoted bone formation.…”

“…The scaffold has an ECM biomimetic structure, which contributes to a likely mechanism that promotes a healing response similar to natural tissue. [97][98][99] During the operation, doctors insert absorbable nanofibrous scaffolds into the suture line between the bone and tendon, and use double-row repair technology to insert nanofibrous scaffolds between the bone and tendon. 99 When the inner end of the fibrocartilage is broken, the Rotiumt scaffold can promote its healing and improve its strength.…”

“…[97][98][99] During the operation, doctors insert absorbable nanofibrous scaffolds into the suture line between the bone and tendon, and use double-row repair technology to insert nanofibrous scaffolds between the bone and tendon. 99 When the inner end of the fibrocartilage is broken, the Rotiumt scaffold can promote its healing and improve its strength. Meanwhile, as a synthetic scaffold, it can decrease inflammatory reaction and cause less scarring at the fibrocartilaginous enthesis than biological scaffolds.…”