Biologic Graft Augmentation Is Associated With Lower Retear Rates and Greater Tendon Thickness Compared With Arthroscopic Rotator Cuff Repair Without Augmentation: A Systematic Review and Meta-analysis of Randomized Controlled Trials

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.