Summary
Augmentation of rotator cuff repairs with a bioinductive collagen patch plus platelet rich plasma improves patient outcomes.
Abstract
Background
Rotator cuff repairs provide pain relief and functional improvement and thus are one of the most commonly performed surgeries worldwide. Healed repairs lead to improved patient outcomes and satisfaction while failed repairs lead to increased dysfunction and healthcare costs. Failures can be due to structural compromise of the repair construct as well as biological factors. There is increasing interest and evidence that various treatment adjuvants, including patches and cell-based therapies, can promote a healthy biological environment to improve rotator cuff healing rates. Our goal was to evaluate several patient reported outcomes, at various time points after surgical repair, of both partial and full thickness rotator tears using a novel technique that combines the use of a collagen based bioinductive implant (BI) in conjunction with platelet rich plasma (PRP).
Methods
A retrospective analysis of prospectively collected data was performed on patients who underwent rotator cuff repair or debridement with or without BI/PRP augmentation with at least one year follow up. Patient reported outcomes scores were analyzed in patients who underwent 1) rotator cuff debridement 2) rotator cuff debridement with BI/PRP augmentation 3) double row repair 4) double row repair with BI/PRP augmentation. The primary outcomes were American Shoulder and Elbow Surgeons (ASES), Simple Shoulder Test (SST), and Visual Analog Scale (VAS) preoperatively and at 6, 12, 24, and 52 weeks after surgery.
Results
A total of 97 patients met inclusion criteria. 27 patients with partial tears who underwent debridement plus BI/PRP demonstrated statistically significant improvements at 6, 12, and 24 weeks in ASES [58. 3±8.4 vs. 52.7±5.1, p=.03; 73.5±8.7 vs. 64.2±8.2, p=.002; 87.7±6.9 vs. 79.5±7.4, p=.001] and at 12 and 24 weeks in SST [7.5±.9 vs. 6.5±.8, p=.001; 9±1 vs. 8.2±.8, p=.01]) scores compared to 14 patients with debridement alone. 21 patients with full thickness tears underwent double row repair plus BI/PRP, compared to 35 patients with repair only. Similar to the partial tear groups, full thickness tears with BI/PRP augmentation demonstrated statistically significant improvements at 12 weeks in ASES [68.7±4.9 vs. 61.6±8.8, p.001] and at 6, 12, and 24 weeks in SST [5.4±.7 vs. 4.9±.8, p=.04; 7.1±.7 vs. 6.3±.9, p<.001; 9.1±.8 vs. 8.5±1, p=.04]. VAS scores were significantly improved in the BI/PRP groups at all time points postoperatively including at final follow up in both partial [1.1±.6 vs. 1.5±.7, p<.05) and full thickness [1±.4 vs. 1.4±.8, p=.04] groups. Furthermore, the minimal clinically important differences (MCID) for each outcome, were consistently met sooner in the augmentation groups [ASES: 12 vs. 24 weeks, SST: 24 vs. 52 (partial only), and VAS: 12 vs. 24].
Conclusion
The use of BI/PRP combined with standard treatment, for both partial thickness and full thickness rotator cuff tears, yields improved patient reported outcomes compared to procedures performed without augmentation. BI/PRP patients reach MCID thresholds sooner, which may aid in earlier return to work and sport.