lifenet: extracellular matrix graft in rotator cuff repair

Conditions: Rotator Cuff Tear

Summary: this trial is to evaluate the effectiveness of the arthroflex® ecm scaffold graph as an augment in rotator cuff repair surgery to reduce the failure rate of rotator cuff repairs for large and massive rotator cuff tears.

this is a prospective, randomized, controlled, multi-center clinical trial to evaluate the effectiveness of an ecm scaffold graft to augment repair of a large/massive rotator cuff tear. the study will involve 70 patients. 35 patients will be randomly assigned to each arm of the study. despite advances in surgical technology, repairs of large (3-5 cm) and massive (\>5 cm) rotator cuff tears (rct) fail between 20%-90% of the time \[1\]. due to their size and increased structural involvement, large or massive rct present a substantial challenge to orthopaedic surgeons. \[16\] the repairs tend to fail at the suture-tendon junction, which is due to several factors, including tension at the repair and quality of the tendon \[1-2,5\]. full thickness tears are uncommon in younger patients, especially those less than forty years old and are usually traumatic in etiology. younger patients also typically fair better following arthroscopic rotator cuff repair with fewer failures and more successful return to pre-injury level of function \[16\]. one strategy to augment repair of large to massive rotator cuff tears has been the development of biological scaffold materials, which are composed of extracellular matrix (ecm). the ecm composing the scaffolds are made from a number of tissues, including, but not limited to, small intestinal submucosa (sis), dermis, and pericardium \[3\]. studies to date include both prospective and retrospective in animal and human models, and include restore, a porcine-derived sis by depuy orthopaedics, graftjacket, a human-derived, non-cross-linked dermis graft by wright medical technology, and zimmer collagen repair, a cross-linked porcine derived dermal graft made by zimmer. restore studies have shown no benefit and some even an increase in repair failure with recommendations not to use to augment repair. graftjacket studies have shown a reduction in graft failure; however, several of the restore and graftjacket studies are limited by a lack of a control cohort. the zimmer graft studies have conflicting results with both an improvement and no improvement in failure rates of repair. the prior studies listed are all in vivo; however, the majority are not randomized trials and thus do not have a control with which to compare data. in addition, some trials include open repairs. a lack of prospective, randomized, controlled, in vivo trials exist that evaluate the ability of the ecm scaffold graft augmentation in large to massive arthroscopic rotator cuff repairs to decrease the failure rate.

Eligibility criteria:
inclusion criteria: * patients with a large (3-5 cm) to massive (\>5 cm) rotator cuff tear who will be undergoing open or arthroscopic repair. the cuff tear size will be determined on pre-operative mri and us. * patients who are willing and able to provide written informed consent for their involvement in the study. * patients who meet criteria for rcr surgery * patients older than 18 years of age exclusion criteria: * patients with addiction to illegal drugs, solvents or alcohol who are actively using or have previously attempted and failed a treatment program. * patients with bacteremia, a systemic infection, or infection of the surgical site. * all those who are prisoners. * patients who are pregnant or nursing. * all those with a condition that may limit a patient's ability to finalize the study or that may cause an undue risk to the patient's health and well-being.

Keywords: rotator cuff tear large rotator cuff tear massive rotator cuff tear ecm extracellular matrix arthroflex