Biologic Graft Augmentation Is Associated With Lower Retear Rates and Greater Tendon Thickness Compared With Arthroscopic Rotator Cuff Repair Without Augmentation: A Systematic Review and Meta‐analysis of Randomised Controlled Trials
Arthroscopy The Journal of Arthroscopic and Related Surgery · 8 Oct 2026
† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.
Why it matters
Retear after rotator cuff repair is common, so knowing whether a graft improves structural healing, and whether that translates into patients feeling better, informs surgical decisions and patient counselling.
The evidence
This meta-analysis pooled 9 randomised trials (about 556 patients) comparing arthroscopic rotator cuff repair with versus without a biologic graft or patch, including human dermal, porcine, and bovine collagen implants. Augmented repairs had roughly one-third the risk of retear on MRI (risk ratio 0.31, 95% CI 0.22 to 0.45) and slightly thicker tendons (about 1.2 mm more, from only 3 trials). ASES and Constant scores were modestly higher, but the UCLA score difference was not significant, and no trial reported whether patients reached a clinically meaningful threshold.
Retear rate: Risk ratio 0.31 (95% CI 0.22 to 0.45; ratio). The interval favours the first group; the size of the benefit needs clinical interpretation.
Why this rigour score?
Meta-analysis of RCTsDesign starting point: 60.8
Raised the score
- Prospectively registered+5.1
- Pools randomised trials+5.1
Lowered the score
No negative adjustments recorded.
Methods at a glance
Recorded assessment- Comprehensive literature searchMet
- Risk of bias assessedMet
- Bias considered in synthesisMet
- Publication bias assessedNot met
- Study exclusions justifiedMet
- Prospective registrationMet
Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.
See the full score breakdown
- Study design starting point
- 60.8
- Compared against current standard of care
- +3.4
- Prospectively registered
- +5.1
- Pools randomised trials
- +5.1
- Comprehensive literature search
- +3.4
- Risk of bias assessed in the included studies
- +3.4
- Risk of bias carried into the synthesis
- +2.5
- Excluded studies listed and justified
- +1.7
- Final rigour score rounded
- 85 / 100
Study design sets the starting point and a ceiling of 96. Recorded methods then adjust the score. Points are shown to one decimal place; the final score uses unrounded values.
Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.
For journal club
1.Given a large reduction in MRI retear but only modest, inconsistent gains in patient-reported scores, which patients (for example, large tears or older patients with poor tissue) would you offer graft augmentation to, and how would you weigh the added cost?
2.How would you counsel a patient about the possible benefits of a biologic patch alongside reported risks such as stiffness, synovitis, or foreign-body reaction?
Original publication title
Biologic Graft Augmentation Is Associated With Lower Retear Rates and Greater Tendon Thickness Compared With Arthroscopic Rotator Cuff Repair Without Augmentation: A Systematic Review and Meta‐analysis of Randomized Controlled Trials