Editorial Commentary: Bio-Inductive Collagen Implant Augmentation Shows Long-Term Cost-Effectiveness, But Clinical Patient Outcomes and Careful Patient Selection Must Guide the Path Forward.

Abstract

Arthroscopic rotator cuff repairs (ARCR) are fraught with low healing rates despite improvements in surgical techniques and constructs. Several studies have emerged showing significant improvements in failure to heal rates when incorporating bioinductive collagen implants (BCI) in the short term. Structural integrity following ARCR is paramount, as retear places exorbitant costs on the health care system and long-term studies have established that clinical outcomes are significantly worse in patients with structural retear. The up-front costs of biologic augmentation is cost-prohibitive in ambulatory surgery centers, where a large portion of ARCR occurs, despite the efficacy of improving rotator cuff repair tendon quality and integrity. This short-sighted, bundled reimbursement paradigm that omits BCI from Current Procedural Terminology coding must be revised considering the long-term cost effectiveness of reducing retear risk following ARCR. As BCI augmentation is established as a dominant strategy, strongly recommended by the American Academy of Orthopaedic Surgeons, to reduce retears and improve patient outcomes, it is critical that long-term clinical studies evaluating patient outcomes drive the indications for implementation of BCI in patients with high risk of repair failure.