EVIDENCE-BASED REVIEWS & RECOMMENDATIONS FROM THE BRAZILIAN SOCIETY OF SHOULDER AND ELBOW SURGERY: BIOINDUCTIVE IMPLANT AUGMENTATION VERSUS CONVENTIONAL REPAIR FOR ROTATOR CUFF TEARS

Abstract

ABSTRACT Introduction: Despite advances in arthroscopic techniques and tendon fixation methods, structural failure after rotator cuff repair remains a relevant clinical challenge, particularly in extensive and massive tears, poor tendon quality, and repairs performed under tension. In this context, tendon-bone healing is recognized as a key determinant of surgical success, driving interest in strategies to optimize the biological environment of the repair, such as bioinductive collagen implants (patches). Methods: A systematic review was conducted in PubMed, Embase, Cochrane Library, and the Virtual Health Library (VHL) up to March 2026, to evaluate whether rotator cuff repair augmented with a bioinductive implant (patch) is more effective than conventional rotator cuff repair for the treatment of rotator cuff tears. The certainty of evidence was assessed with the GRADE approach. Results: Four randomized controlled trials (288 participants) were included, with assessment of the re-tear rate and shoulder function. The results favored bioinductive implant augmentation, mainly through a lower re-tear rate and earlier functional recovery. Conclusion: To date, there is very low-quality evidence that rotator cuff repair augmented with a bioinductive implant (patch) is more effective than conventional repair for the treatment of rotator cuff tears (including complete and massive tears), with respect to the outcomes of re-tear and function. Level of evidence II; Systematic review.