Novel biologic scaffold-anchor may not improve rotator cuff healing vs. standard anchor
Key takeaways:
- A novel bioresorbable scaffold-anchor did not yield superior outcomes for rotator cuff repair vs. a standard anchor.
- Both anchors yielded similar retear rates and outcome scores at 6 months.
Published results showed the use of a novel bioresorbable scaffold-anchor to augment healing after rotator cuff repair may not yield clinically superior outcomes compared with a standard anchor.
“While there are animal studies that suggest that an inlay scaffold augment improves the biology of the rotator cuff healing enthesis, this research shows that the use of an interpositional scaffold-anchor does not improve the healing rates of rotator cuff tears in humans,” Matthew J. Kelly, MD, of the University of Pittsburgh Medical Center, told Healio.
Kelly and colleagues randomly assigned 99 patients with full- or high-grade partial-thickness rotator cuff tears to receive either a standard anchor (n = 49) or the BioWick anchor (Zimmer Biomet; n = 50), an interpositional, bioresorbable scaffold-anchor, to augment healing between June 2018 and July 2019.
According to the study, the primary outcome measure was repair integrity assessed on ultrasound at 6 months postoperatively. Other outcomes included VAS pain scores, American Shoulder and Elbow Surgeons scores, simple shoulder test (SST), muscle strength and range of motion (ROM), which were assessed postoperatively at 3-month intervals.
Kelly and colleagues found retear rates were 22% (n=9) in the bioresorbable scaffold-anchor group and 23% (n=10) in the standard anchor group at 6 months. They also found no significant differences in VAS scores, ASES scores, SST scores, muscle strength or ROM between the groups at 3- and 6-month follow-ups. Kelly and colleagues noted no complications for any patient.
“The direction of rotator cuff repairs is certainly moving strongly toward the use of biologics,” Kelly said. “Although this study did not show any improvement in rotator cuff healing rates with an interpositional scaffold-anchor, biologics are becoming increasingly utilized. The potential for biologics augmentation in the future is significant.”
Perspective
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Unfortunately, rotator cuff failures and retears are an all too familiar issue for shoulder surgeons. There have been many attempts to solve this perplexing issue that still occurs after flawless repairs from the best surgeons in the world.
A new advancement has been the invention and investigation of interpositional bioresorbable scaffold-anchor constructs. The specific advancement in this anchor is a poly(l-lactide)-co-glycoside acid (PLGA) scaffold attached to the anchor to facilitate rotator cuff healing.
This study was a randomized controlled trial to evaluate the effectiveness of PLGA anchors compared with standard anchors. Ultrasound was performed at 6 months, and patient-reported outcomes were collected at 3 and 6 months.
This study showed no difference in retear rates or patient-reported outcomes at 6 months. Long-term follow-up needs to be conducted with larger numbers but it appears, at this time, short-term improvement remains the same between this new innovative technology and standard anchors. The pursuit for rotator cuff healing improvement continues.
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