title: Can Grafts Provide Superior Tendon Healing and Clinical Outcomes After Rotator Cuff Repairs?: A Meta-analysis.
abstract: BACKGROUND
  Arthroscopic repair of large to massive rotator cuff tears commonly retear. To improve healing rates, a number of different approaches have been utilized, including the use of grafts, which may enhance the biomechanical and biologic aspects of the repair construct. However, the outcomes after the use of grafts are diverse.
  
  
  OBJECTIVE
  To systematically review the literature for large to massive rotator cuff tears to determine whether the use of grafts generally provides superior tendon healing and clinical outcomes to the repairs without grafts.
  
  
  METHODS
  Systematic review; Level of evidence, 3.
  
  
  METHODS
  A systematic review of the literature was performed. Clinical studies comparing the repairs with (graft group) and without grafts (control group) were included and analyzed. The primary outcome was tendon healing on either magnetic resonance imaging or ultrasound. The secondary outcome measures included visual analog scale for pain, University of California at Los Angles (UCLA) score, and forward elevation range. Differences between groups in all outcome measures were statistically analyzed.
  
  
  RESULTS
  Six comparative studies (level of evidence 2 or 3) with 13 study groups were included. A total of 242 repairs in the graft group (mean age, 62.5 ± 4.6 years) and 185 repairs in the control group (mean age, 62.5 ± 5.0 years) were analyzed. The graft types utilized included autograft (fascia lata) in 1 study, allograft (human dermis) in 2 studies, xenograft (bovine pericardium, porcine small intestine submucosa) in 2 studies, synthetic graft (polypropylene) in 1 study, and a combination of autograft (the long head of biceps) and synthetic graft (polypropylene) in 1 study. The overall mean follow-up time was 28.4 ± 9.0 months. When 1 or 2 studies/study groups were excluded due to practical or statistical reasons, the graft group demonstrated significantly improved healing (odds ratio, 2.48; 95% CI, 1.58-3.90;P< .0001) and all clinical outcome measures at final follow-up (P≤ .02).
  
  
  CONCLUSIONS
  The use of grafts generally provides superior tendon healing and clinical outcomes compared to repairs without grafts, except for some specific graft types (eg, porcine small intestine submucosa, bovine pericardium). Further investigations are required to determine the benefits of the use of grafts.
authors.affiliation: Department of Surgery, Section of Orthopaedic Surgery, McCaig Institute for Bone and Joint Health, University of Calgary; Calgary, Alberta, Canada.; Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Ono
authors.affiliation: Department of Orthopedic Surgery, Colombia Universidad Nacional de Colombia Graduate School of Medicine, Bogota, Colombia.
authors.forename: Diego Alejandro
authors.initials: DA
authors.lastname: Dávalos Herrera
authors.affiliation: Department of Surgery, Section of Orthopaedic Surgery, McCaig Institute for Bone and Joint Health, University of Calgary; Calgary, Alberta, Canada.
authors.forename: Jarret M
authors.initials: JM
authors.lastname: Woodmass
authors.affiliation: Department of Surgery, Section of Orthopaedic Surgery, McCaig Institute for Bone and Joint Health, University of Calgary; Calgary, Alberta, Canada.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Boorman
authors.affiliation: Department of Surgery, Section of Orthopaedic Surgery, McCaig Institute for Bone and Joint Health, University of Calgary; Calgary, Alberta, Canada.; Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Gail M
authors.initials: GM
authors.lastname: Thornton
authors.affiliation: Department of Surgery, Section of Orthopaedic Surgery, McCaig Institute for Bone and Joint Health, University of Calgary; Calgary, Alberta, Canada.
authors.forename: Ian K Y
authors.initials: IK
authors.lastname: Lo
keywords: graft; repair; rotator cuff; tendon healing