Biologics in Rotator Cuff Surgery: Management of Rotator Cuff Tears With an Extracellular Matrix Patch

Chronic large and massive rotator cuff tears remain a treatment challenge for the orthopaedic surgeon. The use of an extracellular matrix (ECM) biologic patch is an emerging field and offers potential for the treatment of patients with failed rotator cuff repairs or those with tears that are chronic and large in nature. There are several commercially available grafts that are derived from a variety of allogeneic (dermis) and xenogeneic (dermis and small intestinal submucosa) sources. An extensive amount of basic science and preclinical models have demonstrated that an ECM patch may offer improved healing rates with a biomechanical profile that nearly reproduces the characteristics of the native rotator cuff tendon. One should keep in mind the exact application of the ECM patch when interpreting studies, either as an augmentation (onlay) versus interpositional (intercalary) technique, which may significantly alter the overall efficacy of the ECM patch. Although there is an extensive amount of basic science and preclinical work to justify their use in animal models, the application of ECM patches in the human setting has not been as encouraging. The purposes of this paper are to review the basic science and preclinical data on the use of ECM patches, to describe current clinical indications, techniques, and to review the results in both animal and human studies.