Rotator Cuff Tears: What Is Rotator Cuff Augmentation?

Rotator Cuff Tears: What is Rotator Cuff Augmentation?

The rotator cuff muscles surround and stabilize the shoulder joint. Rotator cuff tears result when the tendons of these muscles are torn from the upper arm bone. During an arthroscopic rotator cuff repair, the surgeon may choose to use biologic augmentation to reinforce the repair and support healing.

What is biologic augmentation? Biologic refers to tissue derived from living organisms, such as skin, tendon, or bone; augmentation means adding something to enhance what has already been done, so biologic augmentation means supplementing the repair with a tissue graft. For a rotator cuff repair, biologic augmentation can be performed in 2 ways: by placing a bone graft between the tendon and the bone, or by adding a graft patch on top of the repaired tendon.

This video will focus on the second approach, where a graft made of collagen, the natural protein that forms the building blocks of tendons, is placed over the repair. The patch integrates with the tendon to improve strength and durability.

There are 3 main collagen graft options for this technique. The first option is a xenograft, sometimes referred to as a bioinductive implant. "Xeno-" means foreign, so a xenograft comes from another species, typically a cow or pig to make the collagen patch. While these grafts aim to stimulate healing, research suggests that they may be associated with increased stiffness, higher retear rates, and a greater likelihood of requiring a second surgery. This suggests some patients may have an immune response to xenografts.

The second option is an allograft. "Allo-" means different, so an allograft comes from a human donor who is not the patient. These grafts are processed to remove nearly all DNA and cells, leaving a collagen patch with factors that support tendon healing. Studies have shown that allografts can improve healing, strength, and shoulder function after augmentation.

The third option is an autograft. "Auto-" means self, so an autograft is the patient's own tissue. In the setting of a rotator cuff repair, biceps tendonitis may be treated with a biceps tenodesis, which is the removal of the painful biceps tendon. If the removed tissue is healthy, it is compressed into the collagen graft patch. Autografts are typically cost effective, readily available and integrate well with the repaired tendon.

The surgeon may consider each of these graft options when selecting the right one for the patient's surgery.