Promoting hematoma-like tissue formation in arthroscopic rotator cuff repair: impact of a bioinductive collagen implant

Q2 Medicine

JSES International Pub Date : 2026-05-01 Epub Date: 2026-03-26 DOI:10.1016/j.jseint.2026.101699

Hideki Kinjo MD , Naoki Suenaga MD, PhD , Naomi Oizumi MD, PhD , Jun Kawamata MD , Kotaro Nishida MD, PhD

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Abstract

Background

Hematomas, rich in platelet-derived growth factors, are vital in tendon–bone healing. Reportedly, larger hematoma-like tissue (HLT) surrounding the repaired tissue at 6-8 weeks after rotator cuff repair on T2-weighted magnetic resonance imaging effectively predicts structural outcomes (Sugaya classification type 1) at 6 months post-operatively. Recent studies explored the use of a reconstituted type I bovine collagen bioinductive implant derived from the bovine Achilles tendon to improve healing rates and tissue thickness, leading to favorable clinical outcomes. Therefore, we aimed to evaluate whether using this collagen implant to cover the lateral side of the sutured rotator cuff enhances the HLT size, formation, and maintenance at 6-8 weeks post-operatively.

Methods

In this retrospective cohort study, we analyzed patients who underwent arthroscopic rotator cuff repair using the surface-holding method. Fifty-eight patients were treated without implants (H group), while 58 received bioinductive collagen implants (REGENETEN; Smith & Nephew, Andover, MA, USA) (R group). Magnetic resonance imaging was performed at 1 week and 6-8 weeks post-operatively to evaluate HLT thickness, classified as grades 1 (no HLT), 2 (HLT not exceeding the line connecting the cuff surface and the lateral edge of the greater tuberosity), or 3 (HLT exceeding the line). Retears at 6-8 weeks post-operatively were also assessed.

Results

At 1 week post-operatively, 55.2% of the H group and 60.3% of the R group were classified as grade 3, with no significant difference (P = .71). At 6-8 weeks, 22.4% and 63.8% of the H and R groups, respectively, were classified as grade 3 (P < .05). Moreover, 40.6% and 77.1% of the H and R groups, respectively, maintained grade 3 from week 1 to 6-8 weeks post-operatively (P < .05). In addition, in the H group, no case changed from grade 1 or 2 to grade 3, whereas 37.5% of cases in the R group changed from grade 1 to grade 3 and 50% changed from grade 2 to grade 3. Furthermore, the R group had fewer cases in which the HLT became thinner, disappeared, or experienced a retear compared to the H group (P < .05).

Conclusion

Implanting a reconstituted type I bovine collagen bioinductive implant in arthroscopic rotator cuff repair using the surface-holding method helps to preserve and enhance HLT thickness, with a higher proportion of patients achieving grade 3 HLT at 6-8 weeks post-operatively. These findings suggest the potential of collagen implants to improve tendon–bone healing and structural outcomes.

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关节镜下肩袖修复中促进血肿样组织形成：生物诱导胶原植入物的影响

血肿富含血小板源性生长因子，对肌腱-骨愈合至关重要。据报道，在肌腱套修复后6-8周，t2加权磁共振成像显示修复组织周围较大的血肿样组织（HLT）可有效预测术后6个月的结构预后（Sugaya分类1型）。最近的研究探索了利用牛跟腱重建的I型牛胶原生物诱导植入物来提高愈合率和组织厚度，从而获得良好的临床结果。因此，我们的目的是评估在术后6-8周使用胶原植入物覆盖缝合的肩袖外侧是否能增强HLT的大小、形成和维持。方法在这项回顾性队列研究中，我们分析了采用表面固定法进行关节镜下肩袖修复的患者。58例患者不使用植入物（H组），58例患者使用生物诱导胶原植入物（REGENETEN; Smith & Nephew, Andover， MA， USA）（R组）。在术后1周和6-8周进行磁共振成像以评估HLT厚度，分为1级（无HLT）， 2级（HLT不超过袖带表面与大结节外侧边缘的连接线）或3级（HLT超过这条线）。术后6-8周再撕裂进行评估。结果术后1周，H组和R组分别有55.2%和60.3%的患者分为3级，差异无统计学意义（P = 0.71）。6-8周时，H组和R组分别有22.4%和63.8%的患者被归为3级（P < 0.05）。术后第1周至6 ~ 8周，H组和R组分别有40.6%和77.1%的患者维持3级（P < 0.05）。此外，在H组中，没有病例从1级或2级变为3级，而R组中有37.5%的病例从1级变为3级，50%的病例从2级变为3级。此外，与H组相比，R组HLT变薄、消失或复发的病例较少（P < 0.05）。结论关节镜下肩袖修复中采用表面保持法植入重组型牛胶原生物诱导假体有助于保持和增强HLT厚度，术后6-8周患者HLT达到3级的比例较高。这些发现表明胶原蛋白植入物有改善肌腱-骨愈合和结构结果的潜力。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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