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How to Manage Failed Rotator Cuff Repair: Biologic Augmentation

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Management of Failed Shoulder Surgery

Abstract

Failure of a rotator cuff repair complicates up to 94% of the cases, and revision surgery is often required. Initial good results seem to decrease after 2 years from surgeries; therefore new techniques that could enhance the repair are being developed in order to decrease the retear rate. The procedures that add a biological enhancement, directly or indirectly, fall under the term of biological augmentation. Several types of grafts are currently available, including autografts, xenografts, allografts, and synthetic grafts, each with different advantages and disadvantages, obtaining various degrees of improvement compared to standard repairs. Bioengineering allowed the addition of special molecules and cells to those scaffolds, enhancing the intrinsic biological potentiality and modulating the healing response of the host, with interesting findings. Clinical, functional, imaging, and laboratory data suggest that patch augmentation for rotator cuff repair is a safe procedure that constantly enhances the mechanical strength, resulting in a repair tissue that is healthier and stronger. Application of growth factors and mesenchymal stem cells from different origins, instead, has yet to be applied in human studies, but in vitro and animal experimentations suggest that it will be soon possible to obtain a repaired tendon that is completely similar to the native tissue.

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Authors and Affiliations

  1. Department of Orthopaedics, Sacro Cuore – Don Calabria Hospital, Verona, Italy

    Paolo Avanzi & Claudio Zorzi

  2. Orthopaedic Unit, Casa di Cura “Villa Igea” Hospital, Ancona, Italy

    Luca Dei Giudici & Antonio Gigante

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  1. Department of Orthopaedics, Catholic University, Rome, Italy

    Giuseppe Milano

  2. Department of Orthopaedics, Casa di Cura Villa Valeria, Rome, Italy

    Andrea Grasso

  3. Clínica del Pilar , Zaragoza, Spain

    Angel Calvo

  4. Orthopaedic/Upper Limb, St. Luke’s Hospital, Bielsko-Biała, Poland

    Roman Brzóska

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Avanzi, P., Dei Giudici, L., Gigante, A., Zorzi, C. (2018). How to Manage Failed Rotator Cuff Repair: Biologic Augmentation. In: Milano, G., Grasso, A., Calvo, A., Brzóska, R. (eds) Management of Failed Shoulder Surgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-56504-9_29

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