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Utilization of Injectable Biologic Augmentation in Primary Rotator Cuff Repair: Systematic Review

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Utilization of Injectable Biologic Augmentation in Primary Rotator Cuff Repair: Systematic Review

Olivia Bono, BS, UNITED STATES Bryan Jenkin, BA, UNITED STATES Julaine Forlizzi , MD, UNITED STATES Albert Mousad, BS, UNITED STATES Stephen Le Breton, BS, UNITED STATES Glen Ross, MD, UNITED STATES Sarav Shah, MD, UNITED STATES

New England Baptist Hospital , Boston, Massachusetts, UNITED STATES

2023 Congress ePoster Presentation 2023 Congress Not yet rated

Anatomic Location

Shoulder Rotator Cuff

Diagnosis / Condition

Tears

Treatment / Technique

Arthroscopy

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.

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.

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Utilization of Injectable Biologic Augmentation in Primary Rotator Cuff Repair: Systematic Review

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Utilization of Injectable Biologic Augmentation in Primary Rotator Cuff Repair: Systematic Review

Utilization of Injectable Biologic Augmentation in Primary Rotator Cuff Repair: Systematic Review

Purpose

Methods

Results

Conclusion

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