Augmentation Techniques for Rotator Cuff Repairs

Abstract

» Despite enhanced understanding of risk factors for failure and enhanced surgical repair techniques, the risk for failure of the rotator cuff to heal after surgery is still substantial.» A patient-specific approach to augmentation is essential, with decisions based on tear and patient characteristics.» Augmentation can improve repair strength and promote cellular infiltration, which collectively contribute to better healing outcomes.» Augmentation strategies may improve outcomes in rotator cuff repairs, particularly in high-risk cases; however, there is a lack of consensus among surgeons on the most effective strategies for each scenario.

Fig. 1

Sagittal T1 MRI images demonstrating rotator cuff fatty infiltration with Goutallier grades 2 and 3. The quality of the infraspinatus is a key predictive element of both RoHI and m-RoHI scores. We consider the infraspinatus as a bellwether to help predict rotator cuff healing. MRI = magnetic resonance imaging, mRoHI = modified Rotator Cuff Healing Index, and RoHI = Rotator Cuff Healing Index.

Fig. 2

Image of muscle retraction to the midhumeral head demonstrated with both coronal PD MRI and intraoperative imaging within the rotator cuff illustrating another key element of the RoHI and m-RoHI scores. MRI = magnetic resonance imaging, mRoHI = modified Rotator Cuff Healing Index, PD = proton density, and RoHI = Rotator Cuff Healing Index.

Fig. 3

Coronal PD MRI of tendinopathy at the rotator cuff, highlighting degenerative changes and compromise in the extracellular matrix with potential reduced risk of healing. MRI = magnetic resonance imaging, and PD = proton density.

Fig. 4

Image of tuberosity disease demonstrated with both coronal PD MRI and intraoperative imaging. This compromised bone quality at the rotator cuff enthesis illustrates the deficient integrity of the bone and has a potential impact on healing by hindering proper tendon-bone attachment. MRI = magnetic resonance imaging, and PD = proton density.

Fig. 5

Fig. 5-A Image depicting Rotium synthetic scaffold graft (Reprinted from Atreon Orthopedics with permission). Fig. 5-B Image depicting Biowick synthetic nanofiber scaffold (Reprinted from Zimmer Biomet with permission). Fig. 5-C Image depicting Tetrous bone allograft (Reprinted from Tetrous with permission). Fig. 5-D Image depicting a biphasic interpositional allograft from Credille et al., available under Creative Commons CC-BY license (https://creativecommons.org/licenses/by/4.0/). Fig. 5-E Image depicting a biphasic interpositional xenograft from Dickerson et al., available under Creative Commons CC-BY license (https://creativecommons.org/licenses/by/4.0/). Fig. 5-F Image depicting the crimson duvet.

Fig. 6

Sagittal PD MRI of tendinopathy and fibrovascular scarring in a revision surgery, demonstrating the negative effects of prior procedures on tendon health and potential need for supplemental biomechanical strength. MRI = magnetic resonance imaging, and PD = proton density.

Fig. 7

Augmentation decision tree: a decision tree to guide the selection of augmentation strategies in rotator cuff repair, outlining key patient and tear characteristics that influence the choice of appropriate augmentation strategies. mRoHI = modified Rotator Cuff Healing Index, and RoHI = Rotator Cuff Healing Index.