Abstract
We provide our algorithm for tissue augmentation of rotator cuff repairs based on
the current available evidence regarding rotator cuff healing. A variety of factors
are associated with healing following rotator cuff repair. Increasing tear size and
retraction as well as severe fatty degeneration have been associated with worsening
rates of tendon healing. Given the correlation between tendon healing and postoperative
outcomes, it is important to identify patients at high risk for failure and to modify
their treatment accordingly to minimize the risk of early biomechanical failure and
maximize the potential for structural healing. One approach that may be used to improve
healing is tissue augmentation. Tissue augmentation is the use of tissue patches and
scaffolds to provide rotator cuff reinforcement. Surgical management for rotator cuff
tears (RCTs) continues to be a challenging task in orthopaedic surgery today. Appropriate
treatment measures require an in depth understanding and consideration of the patient’s
prognostic factors such as age, fatty infiltration of the rotator cuff muscles, bone
mineral density, rotator cuff retraction, anteroposterior tear size, work activity,
and degenerative changes of the joint. Using these factors within the Rotator Cuff
Healing Index, we can determine a patient’s surgical treatment that will yield the
maximum healing rate. For nonarthritic RCTs, joint-preserving strategies should be
first-line treatment options. For young, active patients with a reparable RCT and
minimal fatty infiltration, a complete repair can be effective. For young patients
with irreparable RCTs, superior capsular reconstructions, and tendon transfers are
viable options. For elderly patients with low work activity, an irreparable RCT and
significant fatty infiltration, a partial repair with or without graft augmentation
can be attempted if minimal to no arthritic changes are seen.
Level of Evidence
Level V, expert opinion.
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Article info
Publication history
Published online: November 09, 2021
Accepted:
October 18,
2021
Received:
August 26,
2021
Footnotes
See commentary on page 2348
The authors report the following potential conflicts of interest or sources of funding: A.B. reports consultancy for Arthrex, outside the submitted work. P.J.D. reports consultancy and royalties for Arthrex, outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
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© 2021 by the Arthroscopy Association of North America
