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Review
. 2022 Mar 24;10(3):23259671211071146.
doi: 10.1177/23259671211071146. eCollection 2022 Mar.

Benefits of Patch Augmentation on Rotator Cuff Repair: A Systematic Review and Meta-analysis

André Luís Lugnani de Andrade  1 , Thiago Alves Garcia  2 , Henrique de Sancti Brandão  1 , Amanda Veiga Sardeli  3 , Guilherme Grisi Mouraria  1 , William Dias Belangero  4
Affiliations
Review

Benefits of Patch Augmentation on Rotator Cuff Repair: A Systematic Review and Meta-analysis

André Luís Lugnani de Andrade et al. Orthop J Sports Med. .

Abstract

Background: Despite technological advances, the overall retear rate on rotator cuff repair is still high. Patches have shown significant reduction in retear rate and pain scores; however, this is not a universal finding and conflicting results have been shown among functional shoulder scales.

Purpose: To analyze previous controlled trials of the literature to bring a consensus about the effectiveness of patch use on rotator cuff repair.

Study design: Systematic review; Level of evidence, 1.

Methods: The search was conducted in PubMed, Web of Science, EMBASE, Scopus, and Cochrane in April 2020. The results of rotator cuff repair with patch augmentation versus without augmentation (control) were compared through odds ratio (OR), raw mean difference (RMD), and standardized mean difference (SMD) of retear rate; functional shoulder scales; strength; and range of motion (ROM).

Results: Of 733 initial studies, 7 of them met the criteria to be included in the analysis. Compared with the control group, the patch augmentation group had a significantly lower retear rate (OR, 0.32 [95% CI, 0.18 to 0.55]; P < .001), lower pain (SMD, -0.42 [-0.71 to -0.12]; P < .01), a higher University of California Los Angeles Shoulder Rating Scale (RMD, 0.87 [0.15 to 1.60], P = .017), and a trend toward higher strength (SMD, 0.95 [-0.03 to 1.94], P = .05) and lower forward elevation ROM (RMD, -10.50 [-21.86 to 0.67]; P = .06), while no changes were noted for other functional scales or for internal and external rotation ROM.

Conclusion: The results point to benefits of patch augmentation in rotator cuff repair, particularly a reduction in retear rate. More interventional studies with better methodological quality should be conducted to confirm the results of this initial review.

Keywords: arthroscopy; patch; patch augmentation; retear; rotator cuff; shoulder injury; surgery.

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Conflict of interest statement

The authors declared that they have no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
Flow diagram of study selection. ASES, American Shoulder and Elbow Surgeons Shoulder Score; ROM, range of motion; SST, Simple Shoulder Test; UCLA, University of California Los Angeles Shoulder Rating Scale; VAS, visual analog scale.
Figure 2.
Figure 2.
Forest plot of retear rate between patch augmentation and control groups. LL, 95% CI lower limit; OR, odds ratio; UL, 95% CI upper limit.
Figure 3.
Figure 3.
Forest plot of visual analog scale's (VAS) standardized mean difference (SMD) between patch augmentation and control groups. LL, 95% CI lower limit; UL, 95% CI upper limit.
Figure 4.
Figure 4.
Forest plot of functional shoulder scales using the (A) University of California Los Angeles Shoulder Rating Scale (UCLA), (B) Constant, (C) American Shoulder and Elbow Surgeons Shoulder Score (ASES), and (D) Simple Shoulder Test (SST) between patch augmentation and control groups. LL, 95% CI lower limit; RMD, raw mean difference; SMD, standardized mean difference; UL, 95% CI upper limit.
Figure 5.
Figure 5.
Forest plot of range of motion (ROM) for (A) forward elevation, (B) internal rotation, and (C) external rotation between patch augmentation and control groups. LL, 95% CI lower limit; RMD, raw mean difference; UL, 95% CI upper limit.
Figure 6.
Figure 6.
Forest plot of the standardized mean difference (SMD) for muscle strength between patch augmentation and control groups. LL, 95% CI lower limit; UL, 95% CI upper limit.
See this image and copyright information in PMC

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