Document Type : SYSTEMATIC REVIEW
Conquest Hospital, East Sussex Healthcare NHS Trust, United Kingdom
Rowley Bristow Orthopaedic Unit, Ashford & St Peter's Hospitals NHS Foundation Trust, Chertsey, Surrey, United Kingdom
Rowley Bristow Orthopaedic Unit, Ashford & St Peter’s Hospitals NHS Foundation Trust, Chertsey, UK
University Hospitals Bristol and Weston NHS FT, Bristol UK Reading Shoulder Unit, Reading UK
University of Manchester (Undergraduate)
Ashford and St. Peter's Hospitals NHS Foundation Trust, St. Peter's Hospital, Guildford St, Lyne, Chertsey KT16 0PZ
Rowley Bristow Orthopaedic Unit, Chertsey, Surrey, United Kingdom Fortius Clinic, London
Repair of large rotator cuff tears remains a challenging process with mixed success. There is growing interest over the use of patches to augment the repair construct and the potential this has to enhance its strength, healing and associated clinical outcomes. Such patches may be synthetic, xenograft or autograft/allograft, while a variety of techniques have been tried to biologically enhance their integration and performance. The materials used are rapidly advancing, as is our understanding of their effects on rotator cuff tissue. This article aims to evaluate what we currently know about patch augmentation through a comprehensive review of the available literature. We explore the results of existing clinical trials for each graft type, as well as new manufacturing methods, novel techniques for biological enhancement and the histological and biomechanical impact of patch augmentation.
There are promising results in short term studies, which suggest that patch augmentation has great potential to improve success rates. In particular, this appears to be true of human dermal allograft, while porcine dermal grafts and some synthetic grafts have also had encouraging results. However, there remains a need for high quality, prospective clinical trials directly comparing each type of graft and the effect that they have on clinical and radiological outcomes of rotator cuff repair.