George Russell Huffman

Purpose: To perform a systematic review and meta‐analysis of Level I and II randomized studies evaluating biologic graft augmentation in arthroscopic or arthroscopic‐equivalent rotator cuff repair. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines, a systematic literature search was conducted in PubMed, Scopus, Embase, and Cochrane databases. Randomized controlled trials comparing the use of a biologic graft augmentation in adjunct to standard arthroscopic repair were included. A minimum clinical follow‐up of greater than 1 year was required for inclusion. Outcome measures included retear rate, tendon thickness, American Shoulder and Elbow Surgeons score, Constant score, and the University of California Los Angeles score. Random‐effects models were used to calculate mean differences and 95% confidence intervals. Results: From our literature search, 9 randomized controlled trials consisting of 556 patients met criteria for inclusion in the meta‐analysis. The use of biologic graft augmentation showed a significant reduction in retear rates (risk ratio = 0.31; confidence interval: [0.22, 0.45]; P < .00001) and a significant increase in tendon thickness at final follow‐up (mean difference: 1.20 mm; confidence interval [1.14, 1.26]; P < .00001). Meta‐analysis also revealed a significant increase between preoperative and postoperative American Shoulder and Elbow Surgeons and Constant score and a nonsignificant increase between preoperative and postoperative University of California Los Angeles score. Conclusions: Biologic graft augmentation in arthroscopic or arthroscopic‐equivalent rotator cuff repair was associated with lower retear rates and greater tendon thickness. Clinical outcome improvement was less consistent across reported patient‐reported measures, and interpretation should account for heterogeneity in graft type and outcome reporting. Level of Evidence: Level II, systematic review and meta‐analysis of Level I and II studies.

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