2023 ISAKOS Biennial Congress ePoster
Utilization of Injectable Biologic Augmentation in Primary Rotator Cuff Repair: Systematic Review
Olivia Bono, BS, Boston UNITED STATES
Bryan Jenkin, BA, Boston UNITED STATES
Julaine Forlizzi , MD, Boston UNITED STATES
Albert Mousad, BS, Boston, MA UNITED STATES
Stephen Le Breton, BS, Boston UNITED STATES
Glen Ross, MD, Boston, MA UNITED STATES
Sarav Shah, MD, Boston, MA UNITED STATES
New England Baptist Hospital , Boston, Massachusetts, UNITED STATES
FDA Status Not Applicable
Summary
Clinically, while there remains scant data at long term follow-up in favor of PRP, utilization of innovative delivery techniques may reduce the risk of arthroscopic washout of PRP and has been shown to potentially improve retear rates.
ePosters will be available shortly before Congress
Abstract
Purpose
Biologic healing remains a significant challenge as tendon tear recurrence is associated with clinical deterioration in the long-term. Injectable biologic augmentation has been hypothesized to improve tissue quality at the suture-tendon interface. The purpose of this study is to systematically review updated preclinical and clinical evidence from 2010 to 2022 regarding the utilization of injectable biologic supplementation in rotator cuff repair.
Methods
A systematic review was conducted following PRISMA guidelines. Two reviewers performed relevant paper selection with a third arbitrating disputes. In total 40 studies, consisting of 29 preclinical and 11 clinical, were included in the study.
Results
Injectables reported included growth factors, bone marrow- & adipose-derived mesenchymal stem cells (ADSC), and other agents (namely platelet-rich plasma (PRP) & hyaluronic acid). The most common findings for preclinical injectables were increased load-to-failure and improved collagen histological quality. Clinically, all eleven clinical studies (10 PRP, 1 ADSC) indicated no adverse events with similar or improved patient-reported outcomes measures compared to control repairs. In one study, a concentrated PRP globule with fibrin matrix was shuttled over a suture to maintain concentrated PRP at the repair site and demonstrated a statistically significant decrease in retears (P=0.03) on MRI evaluation at 31-month follow-up. A matched cohort study investigating augmentation with ADSCs demonstrated a significantly lower retear rate in the ADSC augmented group than in the control repair group at 28-month follow-up (P<.001).
Conclusion
Clinically, while there remains scant data at long term follow-up in favor of PRP, utilization of innovative delivery techniques may reduce the risk of arthroscopic washout of PRP and has been shown to potentially improve retear rates. Further, ADSCs have been shown to reduce retear rates at 28-month follow-up.