Editorial Commentary: Bioinductive Collagen Implants Reduce Rotator Cuff Retear, yet Cost-Effectiveness and Improvement in Clinical Outcomes Are Unclear.

Abstract

The estimated health care costs of failed arthroscopic rotator cuff retears (RCRs) performed in the United States represent a huge economic burden of greater than $400 million per 2-year period. Unfortunately, retear rates do not appear to have improved significantly since the 1980s, despite advances in surgical technology and the biomechanics of repair. The failure of these advances to translate into improved clinical results suggests that the limiting step in reducing retear rates is biology rather than the biomechanics of repair. Bioinductive collagen implants (BCIs) are an emerging and potentially useful option for biological augmentation. Recent meta-analysis of preclinical and clinical studies demonstrates that biological augmentation significantly lowers the risk of retear. Retrieval studies from human RCR subjects who underwent treatment with BCI demonstrate cellular incorporation, tissue formation, and maturation, providing a logical basis for a reduction in retear rates as well as small increases in tendon thickness at the footprint. Although BCIs show potential as a possible game-changing solution for reducing failure rates of RCR, concerns remain regarding cost-effectiveness analyses and demonstration of functional outcome improvement.