This document discusses rotator cuff augmentation, which involves adding graft material to reinforce rotator cuff repairs. There are several types of grafts, including autografts from the patient's own tissue, allografts from human donors, xenografts from animals, and synthetic grafts. The evidence for whether augmentation improves outcomes comes from a limited number of randomized controlled trials and observational studies of varying quality. While allograft augmentation seemed to produce better results than controls in some studies, the overall evidence is inconclusive due to the low quality and small size of available studies. More research is still needed to determine whether and when augmentation provides meaningful benefits over standard rotator cuff repair without grafting.

1. Rotator Cuf
f
Augmentation
Lennard Funk
Wrightington Upper Limb Unit

2. About us

3. Augments
BIOLOGICAL STRUCTURAL

4. Why?
• Outcomes of healed repair bette
r
• Reduce tension on repai
r
• Improve strength of repai
r
• Reduce stress on suture-tendon interfac
e
• Biological Scaffold

5. Structural Augments
AUTOGRAFT
1. Bicep
s
2. Fascia Lat
a
3. Hamstrings
ALLOGRAFT
1. Human Dermi
s
2. Rotator Cuf
f
3. Achilles Tendo
n
4. PatellaTendo
n
5. Quads Tendon
XENOGRAFT
1. Porcine Dermi
s
2. Porcine Intestinal
Mucosa
SYNTHETIC
1. Absorbable
2. Non-Absor
b
3. ECM Scaffol
d
Hakimi, Int J Exp Path, 2013

6. Chen et al. Expert Rev Med Devices, 2009

7. Ferguson et al.AJSM, 2016
Do they work?
• 1491 publications
• Only 10 clinical studies suf
fi
cient quality
(describe technique & graft used; large-massive tears; outcome healing)
• 2 RCT
s
• 2 Comparativ
e
• 6 Case Series

8. Ferguson et al.AJSM, 2016
Do they work?
Abstract

10. RCTs
Study Characteristics
Results
Ferguson et al.AJSM, 2016

11. Comparative Studies
Study Characteristics
Results
Ferguson et al.AJSM, 2016

12. Case Series
Study Characteristics
Ferguson et al.AJSM, 2016

13. Case Series
Results
Ferguson et al.AJSM, 2016

14. Ferguson et al.AJSM, 2016
Do they work?
Abstract

16. Do they work?
• Inclusion = ‘Large’ cuff tears 3-5c
m
• Exclusion = >5cm; Revisio
n
• Single row repairs in non-augment grou
p
• Powered for 40% failure for single row repairs (= 20 per group
)
• Only 15 in Non-aug grou
p
• 3.3 anchors (aug) vs. 1.9 anchors (non-aug)

17. Summary
• Allograft - better than control ….
“However, the quality of the evidence
supporting this claim is limited and is based
on observational studies that are minimally
controlled.
”
• Xenograft - worse than Control
s
• Synthetic - insuf
fi
cient clinical research
Ferguson et al.AJSM, 2016

18. Conclusion

19. Conclusion

20. Should We have used / still use Them?