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

Abstract

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.

Rotator Cuff Repair Using Coracoacromial Ligament Autograft for Supraspinatus Footprint Augmentation

“…In a recent systematic review, Bailey et al 2 reported a lower retear rate and improved American Shoulder and Elbow Surgeons scores in patients treated with RCR when augmented or interposed with graft. Much of the recent interest in augmentation has revolved around the use of xenografts 3 and synthetics, 4 whichdalong with human allograftdhave significant disadvantages including cost and risk of disease transmission. Use of an autograft would be ideal for the setting of cuff deficiency or footprint augmentation to avoid the aforementioned disadvantages while providing the optimal biological and vascular environment for tissue healing.…”

Editorial Commentary: Long Head Biceps Tendon Can Be Used Like a Split Skin Graft: Mesh It and Augment Rotator Cuff Repairs

“…7 Not surprisingly, shoulder surgeons have explored whether augmentation of cuff repair would not only result in better cuff integrity but also reduce retear rates. 5,[8][9][10] An earlier study by Barber et al has been promising reporting intact repairs in 85% compared with 40% in nonaugmented repairs at a mean follow-up of two years. 9 Similarly, Cai et al have shown that graft augmentation with three-dimensional collagen reduced the retear rate to 14% compared with 34% in a control group who underwent arthroscopic repair only.…”

“…A recent meta-analysis has concluded that the current evidence is not robust. 10 Although small improvements in pain and patient-reported outcome measures and a moderate reduction in retear rates for both synthetic and human allograft patches were observed, study bias and heterogeneity strongly suggested that the results should be interpreted with extreme caution. 10 So maybe autograft, such as the long head biceps tendon, is a better option in these cases?…”

“…10 Although small improvements in pain and patient-reported outcome measures and a moderate reduction in retear rates for both synthetic and human allograft patches were observed, study bias and heterogeneity strongly suggested that the results should be interpreted with extreme caution. 10 So maybe autograft, such as the long head biceps tendon, is a better option in these cases? Jeon et al have used biceps augmentation in anterior L-shaped tears, but they could not demonstrate any differences for clinical outcomes and retear rates when compared to partial repair.…”

Current Biological Strategies to Enhance Surgical Treatment for Rotator Cuff Repair

“…Especially for patients with small to medium tears, significant improvements can be found after physical therapy and surgical treatments (Schmidt et al, 2015). Many clinicians contribute a lot to explore the PROs of surgical treatment for rotator cuff tears and many patients have good outcome postoperatively (Baldwin et al, 2020;Oh et al, 2020;Tashjian et al, 2020). The effect of surgical repair of the rotator cuff tendon is not always satisfactory.…”