The bioinductive collagen implant yields positive histological, clinical and MRI outcomes in the management of rotator cuff tears: A systematic review.

PURPOSE: The aim of this study is to report and discuss the outcomes of clinical, histological and animal studies exploring the application of bio-inductive collagen implants (BCIs) to partial and full-thickness rotator cuff tears (PT- and FT-RCTs) in addition to reporting on cost-related factors.

METHODS: Review of literature was performed using the PRISMA guidelines. A systematic electronic literature search was conducted using the CENTRAL, CINAHL, Cochrane Library, EBSCOhost, EMBASE and Google Scholar bibliographic databases. Microsoft Excel was used to create tables onto which extracted data were recorded. Tables were organized based on the research statement formulated using the PICO approach. No statistical analysis was performed.

RESULTS: Nine studies evaluated clinical and MRI outcomes of BCI augmentation for FT-RCTs, seven evaluated similar outcomes when applied to PT-RCTs, two additional studies were case reports and three studies assessed application to FT- and PT-RCTs without stratification of results, one of which also reported on histological data. Two studies reported on histological data alone, and finally, two reported on healthcare costs. BCI augmentation, alone and combined with rotator cuff repair (RCR), displays generally good histological, postoperative clinical and MRI outcomes for PT- and FT-RCT treatment. Recent economic analyses seem to be in favour of the use of this procedure, when selected and applied for appropriate patient populations.

CONCLUSION: Several studies have shown promising results of BCI application to PT- and FT-RCTs, both concomitantly and independently from RCR. Investigations report promising histological characteristics, improved clinical outcomes, increased tendon thickness, reduced defect size and lower re-tear rates.

LEVEL OF EVIDENCE: Level IV.