Collagen Bridging of Massive Rotator Cuff Tears Using Fascia Lata Autograft Could Provide a Lasting Solution

Shoulder rotator cuff tears are ideally primarily repaired, but large and massive, chronic, and/or retracted tears result in challenges. In response, innovative solutions include superior capsular reconstruction, tendon transfers, subacromial balloon spacer, tuberoplasty, partial repair, and marginal convergence. Recently, an innovation is to use collagen tissue to bridge repair of compromised tendon. Recent research using fascia lata autografts for supraspinatus tendon reconstruction in a rat model shows positive outcomes with structural similarity to normal muscle-tendon interface, decreased fatty infiltration, and increased collagen types I and III, suggesting enhanced mechanical strength. In human subjects, the advantages of autograft outweigh harvest site morbidity, noting that Dacron, Teflon, and xenograft show poor results. Ideally, a graft might be composed of a degradable scaffold, possess mechanical strength, andamalgamate stem cells, growth factors, and matrix proteins to facilitate host-tissueintegration.