AANA Lab Course 1001 - Foundations in Arthroscopy (Resident/Fellow)-Overview of Biologic Grafts and Patches_ Augmentation, Interposition, Superior Capsular Reconstruction and Bio-Inductive Scaffolds- Richard K.N. Ryu, M.D.

Overview of Biologic Grafts and Patches_ Augmentation, Interposition, Superior Capsular Reconstruction and Bio-Inductive Scaffolds- Richard K.N. Ryu, M.D.

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Pdf Summary

This presentation by Dr. Richard K.N. Ryu provides an overview of biologic grafts and patches used in managing massive rotator cuff tears (MRCT), defined as tears involving two or more tendons and exceeding 4-5 cm. Treatment options range from conservative measures to partial repair, augmented repair, interposition grafts, superior capsular reconstruction (SCR), tendon transfers, reverse prostheses, and subacromial spacers.<br /><br />Graft choices include acellular dermal matrix allografts (ADMs), xenografts (porcine, bovine tissues), and synthetic materials. The presentation discusses clinical cases demonstrating augmentation techniques ("rip-stop" tendon-to-tendon repair), interposition bridging grafts in failed repairs, and superior capsule reconstruction aimed at restoring glenohumeral stability and reducing superior humeral translation.<br /><br />The superior capsule, normally 4-9 mm thick, plays a key role in preventing humeral head migration. SCR using thicker grafts (8 mm) more effectively reverses superior translation and decreases subacromial pressure, improving shoulder biomechanics. Clinical case data reveal improved pain, function, and imaging outcomes post-SCR, including increased acromiohumeral distance and patient satisfaction.<br /><br />Further, bio-inductive collagen scaffolds show promise in enhancing biological healing in revision repairs of large or massive tears, with preliminary data indicating high healing rates on ultrasound and MRI in patients with prior failed repairs.<br /><br />Absorbable subacromial spacers have demonstrated statistically significant range of motion improvements in irreparable massive tears.<br /><br />Conclusions emphasize evolving indications for SCR, favoring younger, active patients with intact or repairable subscapularis, minimal osteoarthritis, and good external rotation strength. While these biologic procedures are technically demanding, dermal allografts currently represent the best extracellular matrix option, and bovine Achilles xenografts may find increasing use as bio-inductive aids in revision and partial tears.<br /><br />Overall, biologic grafts and patches offer promising adjuncts to improve outcomes in complex rotator cuff pathology.

Keywords

massive rotator cuff tears

biologic grafts

acellular dermal matrix allografts

xenografts

superior capsular reconstruction

interposition grafts

bio-inductive collagen scaffolds

subacromial spacers

rotator cuff repair augmentation

shoulder biomechanics