Editorial Commentary: Biologic Graft Augmentation Reduces Retear Rates After Rotator Cuff Repair, but Which Rotator Cuff Tears Need a Graft? That Is the Next Step.

Abstract

The cause of rotator cuff (RC) tears is often associated with degenerative "wear and tear," evidenced by the increasing prevalence of this pathology with increasing age. Furthermore, as patients age, the rate of RC healing worsens. Thus, the patients who are most likely to sustain RC tears are also the patients most likely to fail a RC repair (RCR). Recent evidence shows that biologic graft augmentation of RCR results in a significant reduction in retear rates, a significant increase in tendon thickness on postoperative magnetic resonance imaging, and a significantly greater improvement in select patient-reported outcomes. As with any procedure, it is important for surgeons to identify (either preoperatively or intraoperatively) potential causes of failure and to attempt to reduce the chances of failure in some way. Although there is increasing evidence of improved outcomes with biologic graft augmentation during arthroscopic RCR, it is still not clear which RC tears truly need supplementation with a graft. Although certain tools may be used to ascertain which RC tears are at higher risk of not healing, we need further research to determine which demographic factors and tear qualities specifically benefit from graft augmentation compared with standard RCR techniques. This is the next step in the evolution of RC augmentation research.