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How to Manage Failed Rotator Cuff Repair: Biologic Augmentation

  • Paolo Avanzi
  • Luca Dei Giudici
  • Antonio Gigante
  • Claudio Zorzi
Chapter

Abstract

Failure of a rotator cuff repair complicates up to 94% of the cases, and revision surgery is often required. Initial good results seem to decrease after 2 years from surgeries; therefore new techniques that could enhance the repair are being developed in order to decrease the retear rate. The procedures that add a biological enhancement, directly or indirectly, fall under the term of biological augmentation. Several types of grafts are currently available, including autografts, xenografts, allografts, and synthetic grafts, each with different advantages and disadvantages, obtaining various degrees of improvement compared to standard repairs. Bioengineering allowed the addition of special molecules and cells to those scaffolds, enhancing the intrinsic biological potentiality and modulating the healing response of the host, with interesting findings. Clinical, functional, imaging, and laboratory data suggest that patch augmentation for rotator cuff repair is a safe procedure that constantly enhances the mechanical strength, resulting in a repair tissue that is healthier and stronger. Application of growth factors and mesenchymal stem cells from different origins, instead, has yet to be applied in human studies, but in vitro and animal experimentations suggest that it will be soon possible to obtain a repaired tendon that is completely similar to the native tissue.

Keywords

Biologic augmentation Revision Repair Scaffold Shoulder Graft 

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Copyright information

© ESSKA 2018

Authors and Affiliations

  • Paolo Avanzi
    • 1
  • Luca Dei Giudici
    • 2
  • Antonio Gigante
    • 2
  • Claudio Zorzi
    • 1
  1. 1.Department of OrthopaedicsSacro Cuore – Don Calabria HospitalVeronaItaly
  2. 2.Orthopaedic UnitCasa di Cura “Villa Igea” HospitalAnconaItaly

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