A randomized clinical trial to compare the effectiveness of rotator cuff repair with or without augmentation using porcine small intestine submucosa for patients with moderate to large rotator cuff tears: a pilot study

• Published in: Journal of shoulder and elbow surgery 2016-10, Vol.25 (10), p.1623-1633
• Main Authors: Bryant, Dianne, PhD, Holtby, Richard, MD, FRCSC, Willits, Kevin, MD, FRCSC, Litchfield, Robert, MD, FRCSC, Drosdowech, Darren, MD, FRCSC, Spouge, Alison, MD, FRCPC, White, David, PhD, Guyatt, Gordon, OC, FRSC
• Format: Article
• Language: English
• Subjects: Adult; Aged; Animals; Arthroplasty, Replacement - methods; augmentation; Bioprosthesis; Female; Humans; Injury Severity Score; Intestinal Mucosa; Male; Middle Aged; MRI; Ontario; Orthopedics; Pain Measurement; patient-reported outcomes; Pilot Projects; porcine intestine submucosa; randomized clinical trial; Recovery of Function; restore; Rotator Cuff Injuries - pathology; Rotator Cuff Injuries - surgery; Rotator cuff repair; shoulder; Swine; Treatment Outcome
• ISSN: 1058-2746; 1532-6500
• DOI: 10.1016/j.jse.2016.06.006

Background The rate of rotator cuff repair failure is between 13% and 67%. Porcine small intestine submucosa (SIS) may be suitable to augment the repair. Methods There were 62 patients with moderate and large cuff tears randomized to repair alone (control) or augmentation with SIS (Restore Orthobiologic Implant; DePuy, Warsaw, IN, USA). Primary outcome was repair failure using magnetic resonance arthrography. Randomization occurred on completion of the repair. Patients and assessors were blind to group. Assessments occurred preoperatively and postoperatively at 2 and 6 weeks and 3, 6, 12, and 24 months. Results There were 62 patients randomized (34 SIS, 28 control). Patient demographics, rotator cuff tear characteristics, and repair details were similar between groups. At 1 year, risk of failure was 52.9% (18/34) in the SIS group and 65.4% (17/26) in the control group for a risk difference of 12% (80% confidence interval, −7% to 32%) or relative risk of 0.81 (95% confidence interval, 0.53-1.24, P  = .33) in favor of SIS. At 1 and 2 years, the mean difference between groups for patient-reported outcomes was small and consistent with chance but did not exclude the possibility of a clinically important difference. There was no statistically significant difference ( P  = .50) between the SIS group (59.6 ± 38.9; range, 3-112) and the control group (52.7 ± 38.6; range, 5-112) in number of days to being narcotic and pain free (