{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T18:59:26Z","timestamp":1790103566154,"version":"4.0.1"},"reference-count":35,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Biologic augmentation is increasingly used to enhance tendon healing after rotator cuff repair, with recent American Academy of Orthopaedic Surgeons guideline updates supporting certain implants. However, clinically significant benefits to the patient remain unclear. The primary objectives of this study were (1) to assess whether adding biologic augmentation to rotator cuff repair lowers retear rates and (2) to determine whether biologic augmentation yields superior patient-reported outcomes that exceed the minimal clinically important difference threshold for clinical significance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Systematic review and meta-analysis were carried out for Level I randomized controlled trials (RCTs) (PubMed, Embase, and CENTRAL) from inception to January 1, 2025, per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Only RCTs reporting postoperative imaging and patient-reported outcomes of American Shoulder &amp; Elbow Surgeons (ASES), Constant, Simple Shoulder Test (SST), and University of California Los Angeles (UCLA) were included. Random-effects models evaluated retear rates and functional scores; subgroup analyses examined platelet rich plasma (PRP), patch, and other biologics. Mixed-effects models and correlations assessed the relationship between retear and function.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Twenty RCTs (1,327 shoulders) were included. Biologic augmentation reduced the retear rate by approximately 12% (14.8% vs. 26.7%; RR 0.62, 95% CI 0.50-0.76, p &lt; 0.0001; I\n                      <jats:sup>2<\/jats:sup>\n                      = 8%), with significant benefits for both PRP and patch augmentation. Intact repairs had clinically significantly higher ASES (+14.3, 95% CI 10.8-17.8) and Constant (+10.5, 95% CI 7.2-13.8) scores than retorn repairs. However, patient-reported outcomes were not clinically significantly better for augmented repairs (effect size ASES 0.9; Constant 2.18; SST 0.78; UCLA 1.01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>In the included RCTs, biologic augmentation was associated with lower retear rates but not clinically significantly greater patient-reported outcomes after rotator cuff repair.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      <jats:underline>Level I<\/jats:underline>\n                      , evidence-based systematic review. See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.oa.26.00248","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T18:01:29Z","timestamp":1790100089000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Biologic Augmentation Improves Rotator Cuff Integrity But Not Clinically Significant Patient Outcomes"],"prefix":"10.2106","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5529-4494","authenticated-orcid":false,"given":"Jake X","family":"Checketts","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery and Sports Medicine, University of Washington Medical Center, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-1487-576X","authenticated-orcid":false,"given":"Stephen D","family":"Daniels","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Sports Medicine, University of Washington Medical Center, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5891-5196","authenticated-orcid":false,"given":"Corey J","family":"Schiffman","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Sports Medicine, University of Washington Medical Center, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6465-4826","authenticated-orcid":false,"given":"Frederick A","family":"Matsen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Sports Medicine, University of Washington Medical Center, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9774-1849","authenticated-orcid":false,"given":"Jason E.","family":"Hsu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Sports Medicine, University of Washington Medical Center, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,7]]},"reference":[{"key":"R1-20260922","first-page":"151","article-title":"Biologics to improve healing in large and massive rotator cuff tears: a critical review","volume":"12","author":"Goldenberg","year":"2020","journal-title":"Orthop Res Rev."},{"issue":"2","key":"R5-20260922","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1177\/0363546514529644","article-title":"Rotator cuff repair: published evidence on factors associated with repair integrity and clinical outcome","volume":"43","author":"McElvany","year":"2015","journal-title":"Am J Sports Med."},{"issue":"304","key":"R6-20260922","first-page":"78","article-title":"Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan","volume":"304","author":"Goutallier","year":"1994","journal-title":"Clin Orthopaedics Relat Res."},{"issue":"6","key":"R7-20260922","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1016\/S1058-2746(99)90097-6","article-title":"Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging","volume":"8","author":"Fuchs","year":"1999","journal-title":"J Shoulder Elbow Surg."},{"issue":"6","key":"R8-20260922","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1016\/S1058-2746(03)00211-8","article-title":"Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears","volume":"12","author":"Goutallier","year":"2003","journal-title":"J Shoulder Elbow Surg."},{"issue":"11","key":"R9-20260922","doi-asserted-by":"crossref","first-page":"1307","DOI":"10.1016\/j.arthro.2005.08.011","article-title":"Functional and structural outcome after arthroscopic full-thickness rotator cuff repair: single-row versus dual-row fixation","volume":"21","author":"Sugaya","year":"2005","journal-title":"Arthroscopy"},{"issue":"4","key":"R10-20260922","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1016\/j.jse.2011.02.008","article-title":"Platelet rich plasma in arthroscopic rotator cuff repair: a prospective RCT study, 2-year follow-up","volume":"20","author":"Randelli","year":"2011","journal-title":"J Shoulder Elbow Surg"},{"issue":"1","key":"R11-20260922","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.arthro.2012.08.014","article-title":"Plasma rich in growth factors in arthroscopic rotator cuff repair: a randomized, double-blind, controlled clinical trial","volume":"29","author":"Ruiz-Moneo","year":"2013","journal-title":"Arthroscopy"},{"issue":"Suppl 1","key":"R12-20260922","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1007\/s12306-016-0415-2","article-title":"Platelet-rich plasma supplementation in arthroscopic repair of full-thickness rotator cuff tears: a randomized clinical trial","volume":"100","author":"D\u2019Ambrosi","year":"2016","journal-title":"Musculoskelet Surg"},{"issue":"10","key":"R13-20260922","doi-asserted-by":"crossref","first-page":"1623","DOI":"10.1016\/j.jse.2016.06.006","article-title":"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","volume":"25","author":"Bryant","year":"2016","journal-title":"J Shoulder Elbow Surg"},{"issue":"9","key":"R14-20260922","doi-asserted-by":"crossref","first-page":"1894","DOI":"10.1016\/j.jse.2024.03.043","article-title":"An isolated bioinductive repair vs sutured repair for full-thickness rotator cuff tears: 2-year results of a double blinded, randomized controlled trial","volume":"33","author":"Camacho Chac\u00f3n","year":"2024","journal-title":"J Shoulder Elbow Surg"},{"issue":"8","key":"R15-20260922","doi-asserted-by":"crossref","first-page":"1312","DOI":"10.1016\/j.jse.2016.01.036","article-title":"Does application of moderately concentrated platelet-rich plasma improve clinical and structural outcome after arthroscopic repair of medium-sized to large rotator cuff tear? A randomized controlled trial","volume":"25","author":"Pandey","year":"2016","journal-title":"J Shoulder Elbow Surg"},{"issue":"6","key":"R16-20260922","doi-asserted-by":"crossref","first-page":"23259671211006100","DOI":"10.1177\/23259671211006100","article-title":"Efficacy of intraoperative platelet-rich plasma augmentation and postoperative platelet-rich plasma booster injection for rotator cuff healing: a randomized controlled clinical trial","volume":"9","author":"Liu","year":"2021","journal-title":"Orthop J Sports Med"},{"issue":"6","key":"R17-20260922","doi-asserted-by":"crossref","first-page":"1760","DOI":"10.1016\/j.arthro.2023.12.014","article-title":"Augmentation of a transosseous-equivalent repair in posterosuperior nonacute rotator cuff tears with a bioinductive collagen implant decreases the retear rate at 1 year: a randomized controlled trial","volume":"40","author":"Ruiz Ib\u00e1n","year":"2024","journal-title":"Arthroscopy"},{"issue":"1","key":"R18-20260922","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1186\/s13063-019-3504-3","article-title":"Adverse effects of xenogenic scaffolding in the context of a randomized double-blind placebo-controlled study for repairing full-thickness rotator cuff tears","volume":"20","author":"Lamas","year":"2019","journal-title":"Trials"},{"issue":"15","key":"R19-20260922","doi-asserted-by":"crossref","first-page":"1345","DOI":"10.2106\/JBJS.K.00394","article-title":"Use of platelet-leukocyte membrane in arthroscopic repair of large rotator cuff tears: a prospective randomized study","volume":"94","author":"Gumina","year":"2012","journal-title":"J Bone Joint Surg Am"},{"issue":"13","key":"R20-20260922","doi-asserted-by":"crossref","first-page":"2965","DOI":"10.1177\/0363546517719048","article-title":"A midterm evaluation of postoperative platelet-rich plasma injections on arthroscopic supraspinatus repair: a randomized controlled trial","volume":"45","author":"Ebert","year":"2017","journal-title":"Am J Sports Med"},{"issue":"1","key":"R21-20260922","doi-asserted-by":"crossref","first-page":"55","DOI":"10.4055\/cios.2011.3.1.55","article-title":"JP, Kim JY. Effectiveness of subacromial anti-adhesive agent injection after arthroscopic rotator cuff repair: prospective randomized comparison study","volume":"3","author":"Oh","year":"2011","journal-title":"Clin Orthop Surg"},{"issue":"8","key":"R22-20260922","doi-asserted-by":"crossref","first-page":"2136","DOI":"10.1177\/0363546516645518","article-title":"Does pure platelet-rich plasma affect postoperative clinical outcomes after arthroscopic rotator cuff repair? a randomized controlled trial","volume":"44","author":"Flury","year":"2016","journal-title":"Am J Sports Med"},{"issue":"6","key":"R23-20260922","doi-asserted-by":"crossref","first-page":"1439","DOI":"10.1177\/03635465241238982","article-title":"Effect of porcine-derived absorbable patch-type atelocollagen for arthroscopic rotator cuff repair: a prospective randomized controlled trial","volume":"52","author":"Kim","year":"2024","journal-title":"Am J Sports Med"},{"issue":"6","key":"R24-20260922","doi-asserted-by":"crossref","first-page":"1403","DOI":"10.1177\/03635465241239062","article-title":"Leukocyte-poor platelet-rich plasma as an adjuvant to arthroscopic rotator cuff repair reduces the retear rate but does not improve functional outcomes: a double-blind randomized controlled trial","volume":"52","author":"Rossi","year":"2024","journal-title":"Am J Sports Med"},{"issue":"10","key":"R25-20260922","doi-asserted-by":"crossref","first-page":"2240","DOI":"10.1177\/0363546513497925","article-title":"Platelet-rich plasma for arthroscopic repair of large to massive rotator cuff tears: a randomized, single-blind, parallel-group trial","volume":"41","author":"Jo","year":"2013","journal-title":"Am J Sports Med"},{"issue":"10","key":"R26-20260922","doi-asserted-by":"crossref","first-page":"2446","DOI":"10.1177\/0363546514541777","article-title":"Platelet-rich plasma in rotator cuff repair: a prospective randomized study","volume":"42","author":"Malavolta","year":"2014","journal-title":"Am J Sports Med"},{"issue":"5","key":"R27-20260922","doi-asserted-by":"crossref","first-page":"1234","DOI":"10.1177\/03635465231154601","article-title":"Prospective randomized trial of biologic augmentation with bone marrow aspirate concentrate in patients undergoing arthroscopic rotator cuff repair","volume":"51","author":"Cole","year":"2023","journal-title":"Am J Sports Med"},{"issue":"1","key":"R28-20260922","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.jse.2015.09.018","article-title":"SECEC Research Grant 2008 II: Use of platelet- and leucocyte-rich fibrin (L-PRF) does not affect late rotator cuff tendon healing: a prospective randomized controlled study","volume":"25","author":"Zumstein","year":"2016","journal-title":"J Shoulder Elbow Surg"},{"issue":"2","key":"R29-20260922","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1177\/0363546510390780","article-title":"Platelet-rich plasma augmentation for arthroscopic rotator cuff repair: a randomized controlled trial","volume":"39","author":"Castricini","year":"2011","journal-title":"Am J Sports Med"},{"issue":"12","key":"R30-20260922","doi-asserted-by":"crossref","first-page":"1650","DOI":"10.1016\/j.jse.2013.05.002","article-title":"Investigating minimal clinically important difference for constant score in patients undergoing rotator cuff surgery","volume":"22","author":"Kukkonen","year":"2013","journal-title":"J Shoulder Elbow Surg."},{"issue":"2","key":"R31-20260922","doi-asserted-by":"crossref","first-page":"102894","DOI":"10.1016\/j.otsr.2021.102894","article-title":"Establishing minimal clinically important difference for the UCLA and ASES scores after rotator cuff repair","volume":"108","author":"Malavolta","year":"2022","journal-title":"Orthopaedics Traumatol Surg Res."},{"issue":"2","key":"R32-20260922","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1016\/j.jse.2017.09.013","article-title":"Quantifying success after total shoulder arthroplasty: the minimal clinically important difference","volume":"27","author":"Simovitch","year":"2018","journal-title":"J Shoulder Elbow Surg."},{"issue":"1","key":"R33-20260922","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/j.jse.2016.06.007","article-title":"Determining the minimal clinically important difference for the American shoulder and elbow surgeons score, simple shoulder test, and visual analog scale (VAS) measuring pain after shoulder arthroplasty","volume":"26","author":"Tashjian","year":"2017","journal-title":"J Shoulder Elbow Surg."},{"issue":"5","key":"R34-20260922","doi-asserted-by":"crossref","first-page":"1940","DOI":"10.1007\/s00167-022-07223-9","article-title":"Platelet-rich plasma does not improve clinical results in patients with rotator cuff disorders but reduces the retear rate. A systematic review and meta-analysis","volume":"31","author":"Feltri","year":"2023","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"issue":"1","key":"R35-20260922","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1186\/s12891-023-07075-5","article-title":"Early versus delayed mobilization for arthroscopic rotator cuff repair (small to large sized tear): a meta-analysis of randomized controlled trials","volume":"24","author":"Hu","year":"2023","journal-title":"BMC Musculoskelet Disord."},{"issue":"8","key":"R36-20260922","doi-asserted-by":"crossref","first-page":"2608","DOI":"10.1016\/j.arthro.2021.03.010","article-title":"Platelet-rich product supplementation in rotator cuff repair reduces retear rates and improves clinical outcomes: a meta-analysis of randomized controlled trials","volume":"37","author":"Ryan","year":"2021","journal-title":"Arthroscopy"},{"issue":"2","key":"R37-20260922","doi-asserted-by":"crossref","first-page":"e367","DOI":"10.1016\/j.asmr.2023.01.002","article-title":"Resorbable bioinductive collagen implant is cost effective in the treatment of rotator cuff tears","volume":"5","author":"McIntyre","year":"2023","journal-title":"Arthrosc Sports Med Rehabil."},{"issue":"12","key":"R38-20260922","doi-asserted-by":"crossref","first-page":"5271","DOI":"10.1007\/s12325-023-02686-9","article-title":"Economic evaluation of a bioinductive implant for the repair of rotator cuff tears compared with standard surgery in Italy","volume":"40","author":"Rognoni","year":"2023","journal-title":"Adv Ther."}],"container-title":["JBJS Open Access"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.OA.26.00248","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T18:01:35Z","timestamp":1790100095000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.OA.26.00248"}},"subtitle":["A Meta-Analysis of Randomized Controlled Trials"],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":35,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.oa.26.00248","relation":{},"ISSN":["2472-7245","2472-7245"],"issn-type":[{"value":"2472-7245","type":"electronic"},{"value":"2472-7245","type":"print"}],"subject":[],"published":{"date-parts":[[2026,7]]}}}