Background: Rotator cuff tears are among the most common orthopedic pathologies, yet surgical failure rates remain high. Bioaugmentation was implemented to facilitate improved healing functions and lessen retears. This systematic review investigated whether arthroscopy with differing types of bioaugmentation meaningfully improved clinical outcomes compared to standalone arthroscopy.

Methods: A search strategy following PRISMA guidelines was conducted across PubMed, Cochrane, Web of Science, and Virtual Health Library. Two independent reviewers screened the results and filtered for full-text eligibility. The primary data extracted from the studies were demographics, postoperative complications, pain reduction, functional outcomes, and retear rates. Meta-analysis was performed to assess the impact of bioaugmentation with arthroscopy on retear rate healing.

Results: 40 studies from the initial 1338 were retained for final review. Postoperative pain was largely similar between control and treatment groups in most studies. Three bioaugmentations found some statistically significant reduction in pain outcomes, but these outcomes were inconsistent and dissipated overtime. Overall, 10 types of bioaugmentation, including platelet-rich plasma (p<0.0001), leukocyte-poor platelet-rich plasma (p=0.0101), and platelet-rich plasma with autologous thrombin (p=0.0008), showed a statistically significant reduction in retear rates compared to standalone arthroscopy. The only bioaugmentation that led to statistically significant increase of retear rate was platelet-rich fibrin matrix (p=0.0114).

Conclusions: Combined bioaugmentation and arthroscopy statistically significantly reduces retear rates compared to standalone arthroscopy. Pain reduction ability differs based on treatment method, with some bioaugmentations showing statistically significant pain reduction and others showing positive trends towards improvement. PRP and PRP with autologous thrombin were the most impactful interventions, reducing retear rates and aiding in short-term pain reduction. Bioaugmentation should be implemented clinically according to work status and patient preference. 

Arik Tieke is a third-year medical student at Northeast Ohio Medical University pursuing a residency in orthopedic surgery. He has been mentored by Dr. Marc Basson MD, PhD, MBA, who completed his MD at University of Michigan and PHD at Yale University, USA. Dr. Basson is the current dean of Northeast Ohio Medical University. He has been cited almost 12,000 times with publication h-index is 61.