[Patch augmentation of the rotator cuff. A reasonable choice or a waste of money?].

BACKGROUND

Although reconstruction methods have improved, tendon retears remain a major complication associated with rotator cuff repair. With the application of patches, either by interposition or by augmentation, surgeons can attempt to close an irreparable cuff defect or improve the mechanical and biological properties of tendons respectively.

OBJECTIVES

Which factors need to be considered when using a patch and what outcome can be expected?

MATERIALS AND METHODS

Based on the current literature, an overview of the techniques and materials in use and biomechanical and clinical experience is provided.

RESULTS

The literature shows clear improvements in the biomechanical properties of a repair with patch augmentation; in particular, weakened tendons of the anterior supraspinatus and superior infraspinatus benefit most. It is important to keep in mind that each patch material has its own individual properties, which makes comparison of the various patch types difficult. The current scientific evidence is promising, although larger level 1 studies are still required.

CONCLUSIONS

The general use of patches cannot be recommended at this time. Nevertheless, the use of a patch should be considered in patients who are at a high risk of recurrent retears. In future, patches will probably be applied mainly as part of a combined effort, together with biological measures to further reduce retear rates.