The Next Frontier for Rotator Cuff Augmentation? Strength + Bio-Induction

Abstract

Rotator cuff repair (RCR) is one of the most common arthroscopic orthopedic procedures performed worldwide. A high number of clinical and subclinical re-tears exist post procedure, particularly in the subset group of large (>3cm) to massive tears and revision tears (Agrawal 2012; Galatz et al. 2004; Djurasovic et al. 2001; Burkhart et al. 2007). Advances in RCR over the past two decades have nearly eliminated failures related to implant failure. Currently the most common mechanism of failure lies in suture “pull through” at the suture-tendon interface (Mirzayan et al. 2019; Ponce et al. 2013; Ma et al. 2006). The addition of rotator cuff augmentation has seen significant growth, with improved outcomes rates compared to non-augmented repairs. However, each of the most commonly used synthetic and biologic augmentation options have drawbacks. We describe the current overview of RCR augmentation and introduce a novel bio-composite scaffold featuring a highly porous type I collagen scaffold reinforced with bio-resorbable poly(L-Lactide) (PLLA) microfilaments. This scaffold is intended for the reinforcement of soft-tissue repair and uniquely combines bio-inductive properties with load-sharing strength.