TY - JOUR AU - Rashid, Mustafa S AU - Smith, Richard D J AU - Nagra, Navraj AU - Wheway, Kim AU - Watkins, Bridget AU - Snelling, Sarah AU - Dakin, Stephanie G AU - Carr, Andrew J PY - 2020/07/21 Y2 - 2024/03/28 TI - Rotator cuff repair with biological graft augmentation causes adverse tissue outcomes JF - Acta Orthopaedica JA - ActaO VL - 91 IS - 6 SE - Articles DO - 10.1080/17453674.2020.1793613 UR - https://actaorthop.org/actao/article/view/810 SP - 782–788 AB - <p><strong>Background and purpose —</strong> Biological patches can be&nbsp;used to augment rotator cuff tendon repair in an attempt to&nbsp;improve healing and reduce rates of re-rupture. However,&nbsp;little is known about the in vivo tissue response to these&nbsp;patches. We assessed native rotator cuff tissue response after&nbsp;surgical repair and augmentation with 2 commercially available extracellular matrix (ECM) patches.</p><p><strong>Patients and methods —</strong> Patients underwent a rotator cuff repair augmented with either GraftJacket (Wright&nbsp;Medical), Permacol (Zimmer Biomet), or no patch (Control),&nbsp;applied using an onlay technique. A sample of supraspinatus&nbsp;tendon was collected intraoperatively and 4 weeks post-surgery, using ultrasound-guided biopsy. Histology and immunohistochemistry were performed on all samples.</p><p><strong>Results —</strong> The Permacol group (n = 3) and GraftJacket&nbsp;group (n = 4) demonstrated some changes in native tendon&nbsp;ECM compared with the control group (n = 3). Significant&nbsp;disruption of the extracellular matrix of the repaired native&nbsp;supraspinatus, underlying both patches, was observed. The&nbsp;patches did not generally increase cellularity, foreign body&nbsp;giant cell count, or vascularity compared to the control&nbsp;group. 1 patient in the Permacol group had an adverse tissue&nbsp;immune response characterized by extensive infiltration of&nbsp;IRF5+, CD68+, and CD206+ cells, suggesting involvement of&nbsp;macrophages with a pro-inflammatory phenotype. No significant differences in protein expression of CD4, CD45, CD68,&nbsp;CD206, BMP7, IRF5, TGFß, and PDPN were observed&nbsp;among the groups.</p><p><strong>Interpretation —</strong> Histological and immunohistochemical&nbsp;analysis of native tendon tissue after patch augmentation in&nbsp;rotator cuff repair raises some concerns about a lack of benefit and potential for harm from these materials.</p> ER -