Editorial Commentary: Collagen Patch Augmentation of Partial-Thickness Rotator Cuff Tears Appears to Increase Tendon Thickness With Few Complications, but Indications and Efficacy Remain Unclear.

Abstract

Partial-thickness rotator cuff tears disrupt the most structurally sound layers of collagen as tear thickness approaches 50% on either the articular or bursal side. Recent studies of cuff insertional dimensions suggest that a tear of just 3 mm may begin to compromise the most supportive zones. Partial-thickness tears can be effectively treated with debridement or a variety of reparative techniques. However, creating a more biomechanically favorable environment is not sufficient in all cases, given that up to 22% of patients who undergo repair experience tear progression and reoperation. Bioinductive bovine collagen patches represent a relatively recent approach to biologically augmenting cuff repairs. Collagen patches appear to increase mean tendon thickness at short-term follow-up, and complication profiles appear comparable to those of non-augmented tears, although surgeon vigilance for early postoperative stiffness is advised. Patients who undergo patch augmentation may show earlier functional outcome improvement with debridement versus take-down and repair. Ultimately, comparative studies with non-augmented control groups are necessary to better understand the contribution of patch augmentation to improved clinical outcomes. Equally important, consistent reporting and clear definitions of rotator cuff tear progression will be essential to determining whether biologic reinforcement can truly prevent long-term repeat injury.