Patch Augmentation in the Treatment of Partial-Thickness Rotator Cuff Tears Facilitates Tendon Healing and Improves Patient Outcomes: A Systematic Review.

Abstract

To assess outcomes and complications of patch augmentation in the treatment of partial-thickness rotator cuff tears (PTRCTs). A systematic review was conducted identifying studies assessing outcomes after surgical treatment of PTRCT with patch augmentation and 6-month follow-up. Clinical studies with full-text manuscripts were identified using Embase, PubMed, Web of Science, and Cochrane databases between January 1980 and December 2023. Postoperative tendon thickness on magnetic resonance imaging was assessed as well as complications and reoperation rates. Forest plots and 95% confidence intervals were generated from mean differences (MD) in pre-post outcome data. Seven studies met study criteria, and only 1 study had a control group (1 Level III, 6 Level IV). In total, 514 patients were enrolled; 482 used a bioinductive collagen patch. Of those, 446 (93%) underwent debridement and 36 (7%) underwent take down and repair. Thirty-two patients served as a control without augmentation; however, only complications were assessed. In total, 14 (44%) underwent debridement alone and 18 (56%) underwent take down and repair. American Shoulder and Elbow Surgeons (ASES) shoulder scores improved with an MD of 16.9 to 41.3 in patients undergoing augmentation. The ASES shoulder function score improved with MD of 8.2 to 12.0. The ASES shoulder pain score improved with a MD of 3.5 to 4.4. A total of 83% to 93% of patients met a minimum clinically important difference (MCID) in ASES scores at 1 year, and 100% of patients with intermediate grade tears and 79.0% with high-grade tears met an MCID at 2 years. Tendon thickness increased, ranging from 0.8 to 2.0 mm. Postoperative complication rates varied, ranging from 3% to 25%, and reoperation rates ranging from 0% to 19%. Reported complications varied; however, stiffness/adhesive capsulitis was the most prevalent complication, occurring in 0% to 25% of patients. Augmentation was associated with increased tendon thickness and improved functional scores, with 79% to 100% of patients meeting a MCID in outcome scores. Level IV, systematic review of Level III and IV studies.