Benefits of Patch Augmentation on Rotator Cuff Repair: A Systematic Review and Meta-analysis

BACKGROUND: Despite technological advances, the overall retear rate on rotator cuff repair is still high. Patches have shown significant reduction in retear rate and pain scores; however, this is not a universal finding and conflicting results have been shown among functional shoulder scales. PURPOSE: To analyze previous controlled trials of the literature to bring a consensus about the effectiveness of patch use on rotator cuff repair. STUDY DESIGN: Systematic review; Level of evidence, 1. METHODS: The search was conducted in PubMed, Web of Science, EMBASE, Scopus, and Cochrane in April 2020. The results of rotator cuff repair with patch augmentation versus without augmentation (control) were compared through odds ratio (OR), raw mean difference (RMD), and standardized mean difference (SMD) of retear rate; functional shoulder scales; strength; and range of motion (ROM). RESULTS: Of 733 initial studies, 7 of them met the criteria to be included in the analysis. Compared with the control group, the patch augmentation group had a significantly lower retear rate (OR, 0.32 [95% CI, 0.18 to 0.55]; P < .001), lower pain (SMD, –0.42 [–0.71 to –0.12]; P < .01), a higher University of California Los Angeles Shoulder Rating Scale (RMD, 0.87 [0.15 to 1.60], P = .017), and a trend toward higher strength (SMD, 0.95 [–0.03 to 1.94], P = .05) and lower forward elevation ROM (RMD, –10.50 [–21.86 to 0.67]; P = .06), while no changes were noted for other functional scales or for internal and external rotation ROM. CONCLUSION: The results point to benefits of patch augmentation in rotator cuff repair, particularly a reduction in retear rate. More interventional studies with better methodological quality should be conducted to confirm the results of this initial review.