Augmentation of full-thickness rotator cuff tears with a bioinductive collagen implant does not reduce retear rates – a propensity matched cohort study

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PURPOSE: To compare the clinical and radiographic outcomes after full-thickness RC repair with and without performing augmentation with a bioinductive collagen implant (BCI). MATERIALS AND METHODS: Consecutive patients who underwent primary repair of a full-thickness supraspinatus tear between 05/2021 and 11/2023 were retrospectively identified. Patients at elevated risk for retear were defined by biological, radiographic, and intraoperative risk factors. Those who underwent repair with or without concomitant augmentation using a BCI and who had both clinical and radiographic follow-up at 1 year postoperatively were matched in a 1:1 ratio according to age, sex, body mass index, tear size, smoking status, diabetes, and American Society of Anesthesiologists physical status classification. Range of motion (ROM) as well as patient-reported outcome measures (Auto-Constant-Score (CS), American Shoulder and Elbow Surgeons (ASES) Score, Subjective Shoulder Value (SSV), and Visual Analog Scale (VAS) for pain) were recorded. Magnetic resonance imaging performed at 1 year postoperatively was analyzed and the presence of retear was recorded. RESULTS: In total, 149 patients with a radiographic and clinical follow-up at 1 year postoperatively were identified. Of these, 23 patients with BCI augmentation were matched to 23 patients without placement of BCI (48% female, 59.2 ± 8.4 years at surgery). A retear occurred in 5 patients (21.7%) in the BCI augmentation group and in 3 patients (13.0%) in the control group (p = 0.72). No significant difference was reported regarding the CS (77 [71-83] vs. 76 [63-81], p = 0.5), ASES Score (92 [82-98] vs. 90 [84-95], p = 0.8), SSV (90 [80-100] vs. 90 [88-95], p = 0.9), VAS for pain (p = 0.74), or ROM between the groups. CONCLUSION: In this retrospective matched cohort of patients at elevated risk for retear, augmentation of full-thickness RC repair with a BCI was not associated with a reduced retear rate. Moreover, no significant differences regarding clinical and functional outcome were found between the two groups. LEVEL OF EVIDENCE: III - Retrospective case series with a matched control group.